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N210 OLOLC Periop

N210 OLOLC Perioperative Nursing

What are the 2 degrees of surgery urgency? Emergency and Elective
What are the 5 types of surgery? diagnostic, curative, restorative, palliative, cosmetic
What is diagnostic surgery? surgery used to obtain or form a diagnosis. Ex: Biopsy
What is cosmetic surgery? surgery done to revise or change the texture, configuration, or relationship of contiguous structures of any feature of the human body.
What is palliative surgery? surgery for the relief of symptoms or improvement in quality of life; usually in patients with an incurable disease or illness
What is curative surgery? surgery designed to eliminate a health problem; ex: removal of a tumor
What is restorative surgery? surgery done where the purpose is to restore function
What are the 2 types of stressors involved with surgery? Physiological stress response (flight or fight) and the Psychologic stress response
What are the 3 stages of surgery? Preoperative, Intraoperative, and Postoperative
What are the 8 major factors affecting surgical risk? Age, Nutrition, Infection, Chronic disease, Alcohol or Drug Abuse, Medications, Disability, and Smoking
What are the 3 main things performed during the preoperative assessment? 1) identify and correct problems that might increase surgical risks 2) establish baseline data for comparison in intra- and post-operative phases 3) anticipate postop complications
What are the 5 parts of Pre-op nursing management? 1) Pre-op teaching 2) Informed consent 3) Psychological preperation 4) Physical preperation 5) Immediate preoperative nursing interventions
What is involved in preoperative teaching? 1) setting goals to decrease anxiety and facilitate recovery 2) teaching considerations 3) Information such as clarification of procedures, exercises, pain relief, coughing and deep breathing techniques
Who is responsible for obtaining an "informed consent"? What is the only exception when it is not needed? The surgeon is responsible for getting the consent. The only exception is in an emergency situation.
What is the nurse's role in an "informed consent"? The nurse can witness the patient's signature.
What is the criteria for informed consent? 1) must be voluntary consent 2) pt must be mentally competent & legal age 3) adequate disclosure of procedure, intentions, complications, & alternatives 4) sufficient comprehension by pt - terminology 5) an authorized witness
What does the immediate preoperative nursing interventions consist of? 1) preop medications 2) preop checklist
What are the 3 common preop medications? 1) Narcotics: meperdine (Demerol) and morphine 2) Sedatives: secobarbital (Seconal) 3) Anticholingergics: glycopyrrolate (Robinul) and atropine
What things are included in the preop checklist? 1)test results on pt. chart 2)check pt. ID band 3)vital signs 4) remove clothing for hosp. gown 5)instruct pt to empty bladder 6)administer preop meds 7)remove nail polish, jewelry, prostheses, etc
What are the 2 physical environment areas? holding area and the operating room
What is special about the air in an operating room? There is a special ventilation system that filters the air to reduce the bacteria count within it. There are also specific traffic patterns to help reduce bacteria. Restricted areas require a mask, gown, shoe and hair covers, etc.
Who are members of the surgical team? 1)Patient 2)Anesthesiologist/Anesthetist 3)Surgeon 4)Scrub Role 5)RN First Assistant 6)Circulating Nurse
What are the intraoperative goals? no aspiration, adequate cardiac output, adequate tissue perfusion, no injury
What are the 4 types of anesthesia? conscious sedation, general anesthesia, regional anesthesia, and local infiltration
What is conscious sedation? moderate sedation, there is a depressed level of consciousness that doesn't impair the patient.
What is genreal anesthesia? the pt. is unconscious, needs a lot of care and a pt. advocate.
What are the effects of general anesthesia? analgesia, muscle relaxation, loss of reflexes, and decreased level of consciousness
What are the methods of administration of general anesthesia? inhalation and intravenous
What are the common types of inhalation general anesthesia? nitrous oxide, halothane (Fluothane), and enflurane (Ethrane)
What are the common types of intravenous general anesthesia? sodium thiopental (Pentathol)
What are some adjuncts to anesthetics? neuromuscular blocking agents: succinylcholine (Anectine) and pancuronium (Pavulon)
What are the intravenous general anesthetics primarily used for? as induction agents, but may be used alone in short procedures
What are some types of regional anesthesia? spinal anesthesia and epidural anesthesia
What is regional anesthesia? nerve block of particular area of the body
What are the effects of regional anesthesia? produce loss of sensation/movement in treated area, pt. maintains consciousness
What is the role of the circulating nurse during the preop phase? verify operative consent, surgical site, offer comfort and emotional support to the pt.
What is the role of the circulating nurse during the intraop. phase? help position pt. for surgery, padding, documentation, acts as pt. advocate, help anesthesia monitor VS, observes for breaks in aseptic technique, counts all instruments/sponges before and after surgery, reports progess to family, brings specimens to lab
What is the role of the circulating nurse during the postop. phase of surgery? reports to recovery room.
What are some gerontological considerations during the intraoperative phase? lithotomy position can increase risk for bld clot in legs, proper padding important, skin very thin, hearing/mobility problems, normally require less anesthesia and pain med., be aware of any health problems like dementia
What are some complications during the intraoperative phase of surgery? vomiting, hypothermia, hypoxia, anaphylactic reactions, malignant hyperthermia
What is malignant hyperthermia? seems to be genetic, involves muscle cells - have specific receptors that trigger this in pt. appears approx. 20min into surg. with symptoms of tachycardia, muscle rigidity, then elevation of temp.
What should be administered asap when signs of malignant hyperthermia manifest? Dantrolene sodium (skeletal muscle relaxant) and sodium bicarbonate
What does the PACU nurse report? surgical procedure, type of anesthesia, vital signs, any complications, fluid status, catheter/drains/packs/dressing, drug administration in PACU, time last got pain meds.
What are the primary concerns for the patient when arriving in post op? respiratory status and vital signs
What are the unit nurse's responsibility in post-op? assesses respiratory status and vital signs, and performs a head to toe assessment. reviews postop orders
What is the schedule for assessments in postop? Q15min x 1hour, Q30min x 2-3 hours, Q4 hours till discharge.
What are predisposing factors for atelectasis/pneumonia? 1) history of resp. problems 2) thoracic or high abd. surg. 3) age 4) obesity 5) smoking 6) severe postop pain 7) postop immobility
What are the predisposing factors for a deep vein thrombosis (DVT)? 1) lower abd. surgery 2) History of venous problems 3) dehydration, fluid loss 4) prolonged postop immobilization
What are some standard discharge instructions? 1) dietary restrictions 2) activity limitations 3) medication teaching 4) wound care 5) possible complications to watch for.
What are some predisposing factors for risk of infection? 1) obesity 2) diabetes mellitus 3) malnutrition 4) old age 5) steroids
What 2 things should be encouraged in the diet of a post op patient? protein and vitamin C
What are the signs of a paralytic ileus? abscent bowel sounds, no passage of flatus, abdominal distention, potassium levels may be low
Created by: guarddogha