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Adult I Peri--Op

Perioperative Exam 1 Dr Hagan NWACC 13

Discuss Purposes of Surgery 1.To cure or minimize disease 2.To diagnose the specific presense of disease or condition 3.to construct or eliminate defect 4. to enhance form or function 5.to prescribe postop treatment & prognosis; to palliate
Continued purposes of Surgery 6.Offer comfort when cure is not possible 7.to follow up or monitor an incurable disease is inevitable, such as an elective, prophylactic masectomy for a woman at high risk of breast cancer
Nursing care provided for the patient before, during, and after surgery is called _________. Perioperative care
The nursing process is used to make assessments and provide interventions to promote the recovery of health, prevent further injury or illness, and facilitate coping with alterations in ______ and ________. physical structure and function
The conceptual model of perioperative care has four domains which are __________. 1.Safety 2. Physiologic responses 3. Patient & Family Behavioral Responses 4. Health system
Represents the structure elements and other system activities that must be present to support safe, effective, high-quality care. The fourth Domain of perioperative care-Health System
Perioperative care is ________ in nature. This is in contrast to the usual progression of the nursing process, which begins with _______. preventive, assessment
Perioperative nurses base their plans of care on ______ _______and recognized desired outcomes already known
In perioperative care, the patient is assessed for the relevance of the _______, nursing diagnosis are then identified, and interventions planned outcome
The perioperative nursing goal is to ______. promote ans assist the patient and family to achieve a level of wellness equal to or greater than what they had prior to the procedure.
All patients MUST give ________ for surgery. consent
The postoperative phase lasts from _______ to the recovery area from surgery and the last ______ physician visit. follow-up
Surgical procedures are usually classified according to _____, ______, ______. urgency, risk, and purpose
a procedure that is pre-planned and based on the patients choice and availability of scheduling for the patient, surgeon, and facility. This is a non-urgent procedure that does not have to be done immediately. elective surgery
must be done immediately to preserve life or a body part or function emergency surgery
must be done within a reasonably short time frame to preserve healthy, but is not an emergency Urgent surgery
is not critical to survival or function optional surgery
is almost always performed in settings such as a physicians office, an outpatient clinic, or a same day, outpatient surgery setting. Minor surgery
This surgery classification means that the surgical procedure is usually brief, carries a low risk, and result in few complications. minor surgery
may require hospitalization and specialized care, is usually prolonged, has a higher degree of risk, involves major body organs or life threatening situations, and has a greater risk for complications. Major surgery
Because of the use of laser techniques and minimally invasive approaches involving very small incisions have made ______ surgery less traumatic, requiring shortened hospital stays. major
Many surgical procedures,even though they are classified as ______, may be performed on an outpatient (same-day) basis or as a _______ hospital stay. Major/ 23-hour
to make or confirm a diagnosis diagnosis examples : biopsy, exploratory laparotomy
to remove a diseased body part ablative examples: appendectomy, colon resection, amputation
to relieve or reduce intensity of an illness; is not curative Palliative examples: colostomy, nerve root resection, debridement of necrotic tissue, balloon angioplasties, arthroscopy
To restore function to traumatized or malfunctioning tissue OR improve self concept Reconstructive examples: scar revision, plastic surgery, skin graft, internal fixation of a fracture, breast reconstruction
To replace organs or structures that are diseased or malfunctioning Transplantation examples:Kidney, liver, cornea, heart, joints
To restore function of conngenital anomalies Constructive examples: cleft palate repair, closure of atrial-septal defect.
Examples of Emergency surgery would that would be done immediately would be: control of hemorrhage; repair of trauma; perforated ulcer; intestinal obstruction; tracheostomy
Examples of Urgent surgery which would be done within 24-48 hours are: removal of gall bladder, coronary artery bypass, surgical removal of a malignant tumor, colon resection, amputation
There are two types of anesthesia general and regional
involves the administration of drugs by inhalation or intravenous route to produce CNS depression general
occurs when an anesthetic agent is injected near a nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to the CNS receptors Regional
The desired results of ________ anesthesia are loss of consciousness, analgesia, relaxed muscles, and depressed reflexes general
________ anesthesia is often used because it has the advantage of rapid induction, excretion, and reversal effects. Inhalation (general)
List the three phases of general anesthesia. 1.Induction 2. Maintenance 3. Emergence
this phase of general anesthesia begins with the administration of the anesthetic agent and continues until the patient is ready for incision. induction
this phase of general anesthesia continues from the point of incision until near completion of procedure. Maintenance
this phase of general anesthesia starts as the patient begins to awaken from the altered state induced by the anesthesia and usually ends when the patient is ready to leave the operating room; the length of time depends on the depth and length of anesthia Emergence
________ anesthesia is advantageous because it can be used for patients of any age and for any surgical procedure, with the patient unaware of the physical trauma of the surgery General
With General anesthesia there are major associated risks for ________ and _______ depression, postoperative ______ and ________ and alterations in thermoregulation. circulatory, respiratory, nausea and vomiting
The patient receiving Regional anesthesia remains _______, but loses sensation in a specific area or region of the body. In some instances reflexes may be lost awake
Regional anesthesia is especially useful in reducing ________, _______, and length of stay for older adult patients. post-surgical pain, bowel dysfunction
Regional anesthesia may be accomplished through _________ or through _______________, __________, or __________ blocks. major nerve blocks,spinal (sub arachnoid block), caudal, or epidural
are accomplished by injecting a local anesthetic around a nerve trunk supplying the area of surgery such as the jaw, face, extremities. Onset and duration of the block depend on the anesthetic drug,its concentration, the amount injected. Nerve blocks
The addition of __________ to nerve blocks, prolongs the block. epinephrine
is achieved by injecting a local anesthetic into the sub arachnoid space thru a lumbar puncture, causing sensory, motot, and automic blockage. Spinal
This type of anesthesia is used for surgery of the lower abdomen, perineum, and legs. Spinal
Adverse effects of spinal anesthesia may include ________, _______, and ______ retention. hypo-tension, headache, urine
is the injection of the local anesthetic into the epidural space through the caudal canal in the sacrum Caudal
This anesthesia may be used for procedure on the lower extremities or perineum Caudal
involves the injection f the anesthetic through the intervertebral spaces, usually in the lumbar region (although it may also be used in the thoracic or cervical regions) Epidural
This anesthesia is used for surgeries of the arms, shoulders, thorax, abdomen, pelvis, and legs. Epidural
is used on mucous membranes, open skin surfaces, wounds, and burns. Topical
_______ in a 4% to 10% solution is the most commonly used agent; others are _______ and ________. cocaine, lidocaine, bupivicaine
________ anesthetics may be sprayed, spread, or applied with a compress of drug-saturated gauze or cotton tipped applicators. Topical
is the injection of an anesthetic agent such as lidocaine, bupivicaine, or tetracaine to a specific area of the body. Local
______ anesthesia is administered by the surgeon in minor, short term surgical or diagnostic procedures such as a tissue biopsy. Local
_______ may be mixed with the local anesthetic to minimize bleeding by causing local _____________. Epinephrine/vasocontriction
It also helps to prolong the length of analgesia by trapping the anesthesia in the tissue through slowed absorption that results from the vasoconstriction of the surrounding blood vessels. epinephrine
_______ anesthesia may also be injected during general anesthetic procedures to prolong pain relief after the general anesthetic wears off. Local
also called conscious or procedural sedation, is used for short term and minimally invasive procedures. Moderate sedation/analgesia
The patient maintains cardiorespiratory function and can respond to verbal commands while the IV administration of sedatives and analgesics raises the pain threshold and produces an altered mood with some degree of amnesia. Moderate sedation/analgesia
During moderate/sedation analgesia the patient retains the ability to keep his/her _______ open and can respond appropriately airway
This type of anesthesia is often administered by a perioperative, endoscopy, interventional radiology or interventional cardiology nurse moderate sedation/analgesia
A perioperative, endoscopy, radiology, cardiology nurse with specialized training and competence in administering medications and monitoring the patients ____ rate and rhythm, ____ rate, ____, level of consciousness, level of pain, BP, and skin condition cardiac, respiratory O2 saturation
is the patient's voluntary agreement to undergo a paticular procedure or treatment (such as surgery). Informed consent
The responsibility for securing the informed consent from the patient lies with the person who will perform the procedure. the physician
What is the nurse's role in obtaining an informed consent? The nurse may sign as a witness, signifying that the patient signed the consent form without coercion and was alert and aware of the act.
Consent forms are not legal if the patient is ______, ______,______,______, or a ______ (as determined by state laws) confused, unconscious, sedated, mentally incompetent, or minor.
In case of a minor (as determined by state laws) consent may be given in those instances by a _______, ______,_______ or ______. parent, spouse, next of kin, or legal guardian
Most states have a list prioritizing authorized ________. for signing operative consents. next of kin
In emergency situations, the physician may obtain consent over the ________ or by _________. telephone, court order
also legal documents that allow the patient to specify instructions for healthcare treatment should he be unable to communicate these wishes postoperatively. Advanced directive
Two common forms of advanced directives include _______ and _________ for healthcare. living wills / durable power of attorney for healthcare
It is the _____ responsibility to identify factors that affect the risk of a surgical procedure. nurse
The nurse must assess the ______ and _____ of the patient and ________ and establishing a plan of care based on appropriate nursing diagnosis. physical/psychosocial/ family
__________ are designed to meet the patients needs and facilitate recovery as the patient progresses through the perioperative period. Interventions
Examples of Nursing interventions in perioperative care: *review past medical history & documents for evidence of existing or previous medical & nursing diagnosis.*Indentify patients(s) with continuing care needs. *Determine presence & quality of family support. *Determine presence/absence of basic living need
Mutual goal setting involved in perioperative care can be: *Be free from injury & adverse effects related to positioning, retained foreign objects, chemical,physical,electrical hazards,*free from infection,*maintain fluid & electrolyte balance, maintain body temp, be free of DVT (clot), pain managed
Continued mutual goal setting involved in perioperative care can be: *demonstrate an understanding of the physiologic and psychological responses to surgery,*participate in a rehabiliation process following surgery.
The importance of preoperative _____ cannot be over emphasized. Surgery is a major trauma to the body, and preoperative __________ identify risk for complications during and after surgery. Assessment/assessments
Assessment of a surgical patient includes: *Obtaining a health history & performing a physical assessment to establish a baseline data base*Identifying risk factors and allergies that could pose surgical complications,*Identifying meds and treatments the pt is currently receiving,
Continued assessment of a surgical patient includes: Determining the teaching and psychosocial needs of the patient and family, * Determining postsurgical support and referral needs for recovery.
The assessment is often conducted several days before surgery as part of preoperative laboratory screening and teaching; this is referred to as _______ ________. It may be conducted in the hospital,a surgical clinic,an office,or even in the patient's home Pre-admission testing
______ and ______ are at a greater risk from surgery than are children and young or middle aged adults. Infants/older adults
The infant has a _________, making even a small loss of blood a serious concern because of the risk for ________ and the inability to respond to the need for increased O2 during surgery. lower total blood volume/dehydration
Infant's airway is small soft and pliable and frequently have upper ________ infections, such as cold, that can cause _________ and ______. This can cause the pt to develop bronchospasm, stridor, and respiratory arrest. respiratory/airway obstruction and hypoxia.
The ______ also has difficulty maintaining stable body temp during surgery because the _______ reflex is not well developed, making hypothermia or hyperthermia more likely. infant/shivering
Infants lower ______ filtration rate and _______ clearance can lead to a slower metabolism of drugs that require _______ _________. glomerular/ creatnine/ renal biotransformation
Because infants _____ is immature until the first yr of life, the effects of ________ and _______ may be prolonged. liver/ muscle relaxants/ narcotics
Physiologic changes associated with aging in older adults ________ their ability to respond to the stress of surgery, alter the effects of preoperative and postoperative _______ and ______, and prolong or alter _______ healing processes. decrease/medications/ anesthesia/ wound
___________ also increase surgical risk and may require alterations in usual postoperative procedures.For example, a pt with congestive failure may be more easily fatigued and thus unable to be up and about as rapidly after surgery. chronic illness
_______ changes associated with past and current illnesses increase surgical risk as well as the risk for postoperative complications Pathologic
Cardiovascular diseases such as _______, _______, recent ________ or cardiac surgery, heart failure, and dysrhythmias increase the risk for hemmorrhage and hypovelmic shock, hypotension, venous stasis, thrombophlebitis, and overhydration with IV Fluids. thrombocytopenia/ hemophilia/ myocardial infarction
________ disorders, such as pneumonia, bronchitis, asthma, emphysema, and chronic obstructive pulmonary disease, increase the risk for respiratory depression from ______ as well as postoperative pneumonia, atelectasis, and alterations in acid-base balance Respiratory
____ and ____ diseases influence the pt's response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter the metabolism and excretion of drugs and impair would healing. kidney/ liver
_______ diseases, especially diabetes mellitus, increase the risk for hypoglycemia or acidosis, slow would healing and present an increased risk for postoperative cardiovascular complications. Endocrine
Nursing interventions to address age-related changes that increases surgical risk for the older adult CARDIOVASCULAR: *decreased cardiac output, stoke volume and cardiac reserve,*decreased peripheral circulation,*increased vascular rigidity. *Obtain and record base vital signs,*assess peripheral pulses,*teach leg exercises, turning, and ambulation,*document normal activity levels and tolerance fatigue,*monitor fluid admin rate,*allow sufficient time for effects of meds to occur.
Nursing interventions to address age-related changes that increases surgical risk for the older adult RESPIRATORY:*reduced vital capacity*diminished cough reflex*decreased oxygenation of blood*decreased chest expansion and strength of intercostal muscles *obtain and record baseline respiratory depth and rate,*teach coughing and deep-breathing exerises,*teach use of incentive spirometer,*assess color of skin,*explain use of pulse oximeter for monitoring postoperative oxygenation.
Nursing interventions to address age-related changes that increases surgical risk for the older adult CNS:*decreased reaction time and coordination,*reduced short-term memory,*sensory deficits,*decreased thermoregulation ability *orient to surroundings,*institute safety measures,such as keeping environment clear of clutter and using a night light.*allow additional time for teaching,*use appropriate measures to conserve body heat.
Nursing interventions to address age-related changes that increases surgical risk for the older adult RENAL:*decreased renal blood flow,*reduced bladder capacity *monitor amount and times of voiding,*monitor fluid and electrolytes status,*maintain and record input and output.
Nursing interventions to address age-related changes that increases surgical risk for the older adult GASTROINTESTINAL:*increased gastric PH,*prolonged gastric emptying time,*decreased hepatic blood flow,liver mass, and enzyme function *obtain baseline weight,*monitor nutritional status (weight,lab data)*observe for prolonged effects of medications.
Nursing interventions to address age-related changes that increases surgical risk for the older adult INTEGUMENTARY:*decreased vascularity,*decreased skin moisture and elasticity,*decreased subcutaneous fat *assess skin status,*monitor fluid status,*pad and protect bony prominences,*monitor skin for pressure areas,*use minimal amounts of tape on dressings and intravenous sites.
Surgical risk is increased by drugs in the category ANTICOGULANTS: may precipitate hemorrhage
Surgical risk is increased by drugs in the category DIURETICS: may cause electrolyte imbalances, with resulting respiratory depression from anethesia
Surgical risk is increased by drugs in the category TRANQUILIZERS: may increase the hypotensive effect of anesthetic agents
Surgical risk is increased by drugs in the category ADRENAL STERIODS: abrupt withdrawal may cause cardiovascular collapse in long term users
Surgical risk is increased by drugs in the category ANTIBIOTICS in the (mycin group): when combined with certain muscle relaxants used during surgery, may cause respiratory paralysis
Surgical risk is increased by drugs in the category ORAL ANTIDIABETIC medications: (such as metformin hydrochloride) may react with radiologic (x-ray) iodinized contrast dyes, and cause acute renal failure
Many medications are discontinued before surgery, but the nurse should know the _________ and _______ of the pt's drugs as well as the physician orders. purposes/actions
Specific medications may be givin the morning of surgery with sips of water, example: pt's with heart or cardiovascular problems or diabetes millitus
Physical implications of previous surgeries are important to the intraoperative and postoperative phases, example: previous heart or lung surgeries may necessitate adaptations in anethesia and in positioning during surgery.
The pt's _____ and _______ of the surgical procedure to be performed should be assessed. perceptions/knowledge
A pt who is _________ is at higher risk for alterations in fluid and electrolyte imbalance,delay would healing, and wound infection. malnourished
_____ pt's are at increased risk for respiratory, cardiovascular positional injury, deep vein thrombosis, and gastrointestinal problems. Obese
Fatty tissue has a poor __________ and therefore, has less resistance to infection; as a result, postoperative complications of delayed wound healing, wound infection, and disruption in the integrity of the wound are common. blood supply
Pt's with a large habitual intake of _______ require larger doses of anesthetic agents and postoperative analgesics, increasing the risk of drug related complications alcohol
____ drug use may render veins hardened, inflamed, and unusable for anesthesia drug administration. IV
All pt's retain ________ secretions during anesthesia, but smokers, who already have increased mucous secretions and decreased ciliary action in the tracheobronchial tree, have more difficulty clearing the ______ passages after surgery. pulmonary/respiratory
Anesthesia increases irritation in the __________. Especially smokers. tracheobronchial mucosa
Pt's who smoke are at risk for _____ and postoperative _______. hypoxia/pneumonia
Smoking compromises wound healing by _______ blood vessels, impairing blood flow to healing tissues. constricting
Ways to reduce preoperative stress can be listening to music/ relaxation techniques
Presurgical screening tests provide objective data of normal body function.The nurse's role is to ensure that the tests are____to the pt,appropriate specimens are collected,the results are___in the pts record before surgery,& abnormal findings are ____. explained/documented/reported
Usually presurgical screening tests include chest x-ray,electrocardiography,complete blood count,electrolyte levels,& urinalysis. Significant findings include: *elevated WBC-presence of infection,*decreased hematocrit & hemoglobin level-presence of bleeding,anemia,*hyperkalemia or hypokalemia-increased risk for cardiac problems,*elevated BUN or creatinine levels-possible renal failure,*abnormal urine constituent
The timing of _____ is a significant consideration: teaching to far in advance of surgery or when the pt is anxious is less effective. teaching
Pain must be assessed as often as every ____ hours after major surgery 2
Unrelieved postoperative pain should be treated as a serious complication of surgery, not as a normal expectation True
The nurse is responsible for assessment, implemenation, evaluation of a pain mgmt plan and for teaching the pt preoperatively how to communicate and report pain. TRUE
If pain medication is ordered p.r.n., there is a time restriction between doses. True every 2-4 hours
The most common causes of postoperative complications are alterations in _____ and _____ function. cardiovascular/respiratory
During surgery the ____ reflex is suppressed, mucous accumulates in the tracheobronchial passageways and do not ventilate fully. cough
_____ _____ excercises hyperventilate the alveoli and prevent them from collapsing again, improve lung expansion & volume, help to expel anesthetic gases and mucus, faciliate oxygenation of tissues Deep breathing
______ helps remove retained mucus from the respiratory tract and usually is taught in conjuctin with deep breathing. coughing
a device that helps to increase lung volume and inflation of alveoli and facilitates venous return. incentive spirometer
Deep breathing exercises should be done every ___ to ___ hours while the pt is awake for the first 24 hours after surgery and necessary there after, depending on risk factors and pulmonary status 1 to 2
During surgery venous blood return from the _____ is slows, some surgical positions such as ______ position decrease return as well and so leg exercises are individualized to pt needs legs/ lithotomy (pap position)
Turning in bed improves _____ return, ______ function, and _______ peristalsis and prevents the unrelieved skin pressure that would occur if the pt were to remain in one position. venous/ respiratory/ intestinal
To turn in bed, the pt should raise one _______, reach across to grasp _____ on the other side toward which he/she is turning and roll over while pushing the bent leg and pulling on the side rail knee/ rail/
The pt should turn and change positions in bed every _____ hours when awake. 2
Certain nursing interventions are appropriate for all surgical pts in the areas of hygiene and skin preparation, elimination, nutrition, and fluids and rest and sleep. True
The nurse is responsible for the _____ and _____ of the pt on the day of surgery. preparation/ safety
Emptying the bowel feces is no longer a routine procedure before surgery, BUT the nurse should use preoperative assessments to determine the need for an order to facilitate bowel elimination. True
If a pt has not had a bowel movement for several days or has had preoperative ______ diagnostic tests, an enema helps prevent postoperative constipation. barium
If an indwelling catheter is not in place, the pt should void immediately before receiving __________ to ensure an empty bladder during surgery. preoperative medications
Effective coughing includes: *semi-fowler position, leaning forward,*Provide a pillow,*inhale and exhale deeply and slowly thru nose 3x's,*take a deep breath and hold for 3secs,*hack out for 3 short breaths,*repeat every 2 hours while awake
If the pts screening tests show a hemoglobin level of less than _____ and a hemocrit of less than ______, blood or blood componet therapy may be given preoperatively to maintain volume and increase the oxygenation of tissue during surgery. 10g/dl, 33%
Current practice is to allow pts to drink liquids or eat food up to ____ hours before surgery depending on type of surgery and with permission of physician 2
If clear liquids are allowed, they should be carefully defined for the pt, and include _____, _______,______,______, and ______. water/ fruit juice w/o pulp/ carbonated beverages/clear tea/black coffee
Preoperative medications that might be prescribes are as follows: *sedatives *anticholinergics *narcotic analgesics *neuroleptanalgesic *Histamine 2 blockers
Reason for Sedatives prescribed prior to surgery: Such as *diazepam (Valium) *midazolam (versed),*lorazepam (Ativan) to alleviate anxiety and decrease recall of events related to surgery.
Reason for Anticholinergics prescribed prior to surgery: Such as *atropine *glcopyrrolate (Robinul) to decrease pulmonary and oral secretions and to prevent laryngospasm
Reason for Narcotic analgesics prescribed prior to surgery: Such as *morphine *meperidine hydrochloride (Demerol) to facilitate pt sedation and relaxation and to decrease the amount of anesthetic agent needed
Reason for Neuroleptanalgesic agents prescribed prior to surgery: such as *fentanyl citratedroperidol (Innovar) to cause a general state of calmness and sleepiness
Reason for Histamine-2 receptor blockers prescribed prior to surgery: such as *cimetidine (Tagment) *ranitidine (Zantac) to decrease gastric acidity and volume
The plan of care is effective if the pt is physicaly and emotionally prepared, verbalizes expected _____ & ______ of the perioperative period, and demonstrates postoperative exercises and activities. events and sensations
re-read section Assessing p836 Taylor book (Nursing process for intraoperative care)
During surgery, nurses function as ____ nurses and _____ nurses in an expanded role as RN first assistants. scrub/ circulating (RNFA) Taylor p838
a member of the sterile team who maintains surgical asepsis while draping and handling instructions and supplies. scrub nurse
identifies and assesses the pt on admission to the operating room,collaborates in safely positioning the pt on the operating bed,assists with monitoring the pt during surgery,provides additional supplies,maintains environment safety. circulating nurse(RNFA)
Why does the circulating nurse count the # of instruments, needles, & sponges used during surgery to prevent the accidental loss of an item in the open incision
The pt is placed in a specific operative position ______ anesthesia has produced loss of consciousness and reflexes. After
The risk of skin injury is avoiding by ______, rather than rolling or pulling the pt into surgical position. lifting
Perioperative nurses need to know the _____ to be used and significant nursing considerations for that position. Position
position that requires lowering the upper torso and raising the feet. Is commonly used in minimally invasive surgery of the lower abdomen or pelvis. Trendelenburg
The reason for the use of the Trendelenburg position is that the displacement of the abdominal viscera toward the head decreases diaphragmatic movement and respiratory exchange;blood pools in the upper torso, and blood pressure increases;NOTE hypotension can result when placed back into supine position.
Shearing with resultant tissue damage is also a significant risk in this position. Trendelenburg
position is used for gynecologic, rectal, and urologic procedures. Lithotomy
The placement of legs in stirups causes pooling of blood in the legs, increasing the risk of thrombophlebitis. Pressure can also damage the peroneal nerve, resultant foot drop. Lithotomy
When a pt is draped the only area left exposed is the ______ site. incision
In some cases plastic adhesives drapes may be used to form a complete seal over the skin, with these drapes, _____ is visible, & the incision is made through the impermeable adhesive drape. skin color
Through surgery, the ________ nurse documents ongoing pt assessment, item counts, monitoring data (vital signs, urine output, blood loss,etc),positioning, medications, dressings and drains, specimans, and responses to care on the intraoperative record. perioperative
Transferring the pt from the operating bed to a stretcher or bed is a critical time becuase sudden or rough handling can cause severe hypotension or potentially lethal cardiac or respiratory arrest. TRUE
The _____nurse verbally communicates relevant preoperative and intraoperative assessments and interventions to the PACU nurses to ensure continuity of care. OR operating room
The primary objective of the hand off report from OR nurse to PACU nurse is to provide accurate information about: the pts care, procedure, presenting condition, and any important events that occurred during the procedure.
convalescense return to health after surgery
Care in the PACU involves assessing the postoperative pt, with emphasis on preventing complications from ______ or the surgery. anesthesia
Assessments made in the PACU include: respiratory status, cardiovascular status, CNS status, fluid status, wound status, and general condition
Postoperative assessments are made every ____ to _____ minutes 10 to 15
Children can quickly loose their _____ and go into crisis in postop. airway
_______ delirium where they wake up thrashing and disoriented, is common in children. Emergence
The average PACU stay is ____ hour(s), nut will vary with each type of surgery, length of anesthesia, and pt response. 1 hour
The critical role functions of the PACU nurse include: vigilant monitoring during emergence from anesthesia and the first hours after surgery, pain mgmt, fluid and electrolyte balance, stabilization of physiologic parameters (such as heart and respiratory rate), AND preparation of the next level of care.
assessed by monitoring respiratory rate, rhythm, and depth; auscultating breath sounds; noting the oxygen saturation level; assessing skin color; and monitoring the cardiovascular and mental status. Respiratory status
During a surgical procedure with general anesthesia, an ________ tube may be inserted to administer the anesthetic gases and maintain patent (not blocked) air passages. endotracheal
The airway or tube is not removed until the _______ and ______ reflexes return, allowing pt to control tongue, cough, swallow. laryngeal/ pharyngeal
In checking respiratory status the airway is checked for _____, humidified O2 is administered, and ____ is initiated. patency/pulse oximetry
______ _______ function is indicated by restlessness and anxiety; unequal chest expansion with the use of accessory muscles; shallow noisy respirations; cyanosis; and tachycardia. Ineffective respiratory
_____ ______ is the most common PACU emergency. Respiratory obstruction
Respiratory obstruction may occur as a result of ______ _______, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema. secretion accumulation
_______ _______is indicated by assessments of ineffective respiratory function plus observing for wheezing or crowing sounds with respiratory effort. Respiratory obstruction
What do you do if a pt is experiencing respiratory obstruction? Positioning, administering humidified O2, encouraging the pt to take deep breaths, and suctioning may be used to maintain a patent airway and tissue oxygenation.
_____ ______ is assessed by taking vital signs, monitoring electrocardiogram rate and rhythm, and observing skin color and condition. Cardiovascular status
When assessing cardiovascular status, _____ _____ findings are compared with baseline data from the preoperative period. Blood Pressure
______ _______ can occur as a result of anesthetic effects, respiratory insufficiency, the surgical procedure, or the excitement phase of recovery from anesthesia. Transient hypertension
_______ may be the result of varied factors including anesthetic agents, preoperative medications, position changes, blood loss, respiratory alterations, and peripheral blood pooling. Hypotension
Intervention for hypotension after surgery includes: O2 administration, deep breathing, leg exercises, verbal stimulation (to expel anesthetic gases and facilitate increasing level of consciousness), and maintaining accurate IV flow rates can increase low blood pressure.
Pts are at risk for _____ ____ ____ related to the surgical procedure, its length, anesthetic agents, a cool enviroment, age, and use of cool irrigating or infusion fluids. altered body temperature
temperature below 35.5C (96F) Hypothermia
can lead to complications of poor wound healing, hemodynamic stress, cardiac disturbances, coagulopathy, delayed emergence from anesthesia, and shivering and its associated discomfort Hypothermia
a disease or condition affecting the blood's ability to coagulate coagulopathy
Nursing interventions for a pt with hypothermia are: measure the pts body temp, usually by temporal or tympanic route, and initiate interventions if the pt complains of being cold or hypothermic. *warmed blankets placed on the pts body and head and forced warm air devices are used for rewarming.
____, an early symptom of shock, must be carefully evaluated. Tachycardia
When assessing cardiovascular status, all _____ are checked for bilateral equality, rhythm, rate, and character. pulses
Assessments of ____ rhythm, _____ of pulses, or tachycardia are of Special significance. irregular/ absence
Other related assessments for _____ are a decreasing blood pressure, cyanosis, a cool skin temp, and a decrease of urine output shock
_____ ______ may result from factors such as preoperative fluid restriction, fluid loss during surgery, wound drainage, or the surgical stress response (with retention of sodium and water). Fluid imbalance
Imbalanced fluid volume (deficit or excess) is a risk to all surgical pts but is an especially important consideration in ______ and _______. children/ older adults
Assessing for fluid status includes: skin turgor, vital signs, urine output, wound drainage, and IV fluid intake.
____ _____ _____ assessments include type of fluid infused, the rate, location of lines, condition of the IV insertion site, and the security and patency of the tubing. IV fluid administration
The nurse in the PACU assesses the ______ over the incision for amount, consistency, and color of drainage as well as for any tubes or drains and the amount and type of drainage by that route. dressing
Large amounts of bright red drainage, combined with other abnormal physical status assessments (restlessness, pallor, cold moist skin,decreasing BP, increasing pulse and respiratory rates), may indicate ____ & _____shock and should reported immediately. hemorrhage/ hypovolemic
is characterized by salt (sodium) depletion and thus differs from dehydration, which is defined as excessive loss of body water./basically means low blood volume. Hypovolemic
Early administration of _______, using nonsteroidal anti-inflammatory drugs and opiates, occurs in the ______. analgesia/ PACU
________ methods to decrease pain and improve comfort include positioning, verbal reassurance, and touch. Nonpharmacologic
_______ _______ of methods that are personally effective for the pt assist in effective implementation in the PACU, These should supplement, not substitute for, pharmacologic pain relief. Preoperative assessment
The pt is discharged from the PACU when _____ status and level of _______ is considered stable. physical/ consciousness
The nursing process for ongoing postoperative care starts after pt is transferred from PACU to room and starts with an initial assessment using data from the ____ and _____ phases. preoperative/ intraoperative
The initial assessment for postoperative care is often combined with the implementation of ______ ______ ______. postoperative physicians orders
After conducting the assessment (unit postoperative care) _______ the time of arrival and all assessment ______. arrival/ data
Agency protocol is followed for assessment routines: Common time frames are every __ mins until stable, changing to every __ to __ hours for first 24 hours, and every ___ hours thereafter. 15 min/ 1 to 2/ 4
Although agency protocols are used for guidlines in the immediate post operative period, the ______ is responsible for adjusting the frequency and priorities of assessment to the specific needs of each pt. nurse
If the pt is not fully conscious, place in the ________ position. side-lying
Specific cardiovascular complications include: hemorrhage, shock, thrombophlebitis, and pulmonary embolus
____ is an excessive internal or external blood loss, and may lead to hypovolemic shock. hemorrhage
Hemorrhage may occur from the following: slipped suture, dislodged clot in the wound, or stress on the surgical site; it may also be the result of pathophysiologic conditions or certain medications.
Common manifestations of hemorrhage include: restlessness, anxiety, and frank bleeding as well as hypotension; cold clammy skin; a weak thready, and rapid pulse; cool, mottled extremities; deep, rapid respirations; decreased urine output; thirst; and apprenhension.
The primary purposes of care for the pt experiencing a hemorrhage include: stop the bleeding,& replace blood volume.
If bleeding occurs, apply pressure to the ____ _____, _______, and be prepared for the pt to return to the ____ ____ if bleeding cannot be stopped. bleeding site, notify the surgeon immediately, operating room
is the body's reaction to acute circulatory failure as the result of an alteration in circulatory control or a loss of intravascular fluid. shock
The most common type of shock seen in postoperative pts is _______ shock, which occurs from a decrease in blood volume. hypovolemic
Common manifestations of shock are the same as ________. hemorrhage
The primary purpose of care for a pt in shock is to: improve and maintain tissue perfusion by eliminating the cause of the shock.
Nursing interventions for shock include: notify the surgeon immediately, establishing & maintain the airway;placing the pt in flat position with legs elevated 30-45 ;administering O2, monitor vital signs,hematocrit,& blood gas results;maintaining body warmth with covers;administering medications
continued Nursing interventions for shock ALSO include: nurse should be prepared to assist with the insertion of IV lines and to administer fluids as well as whole blood or its componets
_____ is an inflammation of a vein associated with thrombus (blood clot) formation. Thrombophlebitis
Manifestations of thrombophelbitis are: pain and cramping in the calf or thigh of the involved extremity, redness, and selling in the affected area, elevated temp, and an increase in the diameter of the involved extremity.
Care for the pt with thrombophelbitis includes: preventing a clot from breaking loose and becoming an embolus that travels to the lungs, heart, or brain and preventing further clot formation.
Nursing interventions for thrombophelbitis include: administer meds(ex. anti-inflammatory agents, anticoagulants, analgesics),maintain the pt on bed rest,apply external heat, apply thigh high antiembolic stockings or sequential pneumatic compression devices,& measure bilateral calf or thigh circumference.
How often does the nurse measure bilateral calf or thigh circumference. Every shift
Should the pt or nurse massage the legs when they have thrombophelbitis? NOOOOO
Nursing interventions to prevent or monitor for respiratory complications include: monitoring vital signs; implementing deep breathing, coughing, and incentive spirometry; turning in bed every 2 hours; ambulating; maintaining hydration; avoiding positioning that decreases ventilation;& monitoring responses to narcotic analgesics.
Specific respiratory complications include: pulmonary embolus, pneumonia, and atelectasis
____ is a blood clot or foreign substance that is dislodged and travels through the bloodstream until it lodges in a smaller vessel. Embolus
In postoperative pts a embolus is often part of a _______ that breaks freee from a vein wall. thrombus
If the embolus lodges in pulmonary vessels, it is called a _____ _____. pulmonary embolus
Manifestations of a pulmonary embolus include: dyspnea (difficult breathing), chest pain, cough, cyanosis,rapid respirations,tachycardia (abnormally rapid heart rate), and anxiety
A pulmonary embolus is a life threatening condition and _______treatment is necessary. immediate
The primary goal of care are to ______ cardiovascular and respiratory function and to prevent further emboli. stabalize
Nursing interventions for pulmonary embolus include: notify physician immediately,maintain the pt on bed rest in semi-fowler position,assess vital signs frequently,administer O2,adminster meds(anticoags,analgesics),& instruct pt to avoid Valsalva's maneuver to prevent increased intrathoracic pressure.
forced exhalation against a closed glottis, such as straining to have a bowel movement valsalva's maneuver
is an inflammation of the alveoli as the result of an infectious process or the presence of foreign material. Pneumonia
______ may occur postoperatively as a result of aspiration, infection, depressed cough reflex, increased secretions from anesthesia, dehydration, and immobilization. Pneumonia
Manifestations of pneumonia include: fever, chills, a cough that produces rusty, or purulent sputum, crackles and wheezes, dyspnea, and chest pain
The goals of care are to treat the: underlying infection, maintain respiratory function, and prevent the spread of microorganisms.
Nursing interventions for pneumonia include: promoting full aeration of lungs by positioning the pt in semi-fowlers or fowlers position,administering O2,administering meds(antibiotics, expectorants,analgesics),provide frequent oral hygiene,ensuring rest&comfort
is the incomplete expansion or collapse of alveoli with retained mucus, involving a portion of lung and resulting in poor gas exchange. Atelectasis
Manifestations of atelectasis include: decreased lung sounds over the affected area, dyspnea, cyanosis, crackles, restlessness, and apprehension.
The primary goals of care for atelectasis are to: ensure oxygenation of tissues,prevent further atelectasis, and expand involved lung tissues.
Nursing interventions for atelectasis include: those used to prevent or monitor for respiratory complications, and positioning the pt in semi-fowlers position, administering O2, and administering analgesics for pain.
When preventing surgical site complications the nurse assesses and cares for the surgical site to promote: healing & prevent complications such as infection,dehiscence (wound closure seperation), & evisceration (protrusion of intra-abdominal organs)
Nursing interventions to prevent surgical site complications are: assessing vital signs (especially fever);maintaining hydration & nutritional status;encouraging a diet high in proteins,carbs,calories,vitamins;using proper hand hygiene;&following aseptic technique when changing dressings and exit sites on tubes & drains
Assess for the return of peristalsis by auscultating bowel sounds every ___ hours when the pt is awake. 4
Assess ____ ______, especially if bowel sounds are not audible or are high pitched. abdominal distention
High pitched bowel sounds are indicative of possible ___________ paralytic ileus-which is an absence of intestinal peristalsis.
Assess ability to pass _____ and ____. flatus/ stool
Assist with _______ in bed and ambulation to relieve gas pains, a common postoperative discomfort. movement
To help elimination needs postoperatively encourage food and fluid intake when ordered, especially ______ and ______. fruit juices/ high fiber foods
In meeting urinary elimination needs postoperatively: *monitor patterns of intake n output*assist in assuming normal position when using any form of bathroom tools*maintain prescribed intravenous fluid infusion rates*encourage oral fluid intake when prescribed, initiate urinary catherization if prescribed
Assess bladder distention by palpating above the symphsis pubis, if the pt has not voided w/in ___ hrs after surgery or if the pt has been voiding frequently in amounts of less than __ ml; notify the physician of abnormal assessment results. 8/50
The usual length of time from completion of surgery to discharge is ___ to ____ hours, provided that the pt is no longer dizzy or drowsy, stable vital signs, voided, accompanied by an adult. 1 to 3
In promoting rest and comfort which means preventing nausea and vomiting postoperatively includes: *avoid giving pt large amounts of fluids or food at one time especially after NPO)*administer prescribed meds*provide oral hygiene as needed*clean environment*Avoid using a straw*avoid strong smelling food*assess for alergies to meds (antibiotic,analgesic
In promoting rest and comfort which means preventing thirst postoperatively includes: *offer sips of water or ice chips when NPO permitted *maintain oral hygiene
In promoting rest and comfort which means preventing hiccups postoperatively includes: *take several swallows of water while holding breath (IF not NOP)*rebreathe into a paper bag *eat a tsp of granulated sugar
In promoting rest and comfort which means preventing surgical pain postoperatively includes: *Assess pain frequently; administer prescribed analgesics every 2 to 4 hours on a regular schedule during the first 24-36 hours after surgery *Reinforce preoperative teaching of pain mgmt *offer nonpharmacologic measures to supplement medications (music)
Created by: mwiseman