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Perioperative care
Lpn fall 2008
| Question | Answer |
|---|---|
| 3 phases of perioperative care | preoperative, intraoperative, postoperative. |
| Perioperative care | care pts receiver before, during & after surgery. |
| Current trend | to facilitate as short a perioperative period as possible, control health care cost by facilitating pt’s recovery in the comfort & support of home environment. |
| Preoperative period1 | starts when pt’s or families in an emergency, lean that surgery is necessary & ends when pt’s are transported to operating room. |
| Preoperative period2 | May be short or long; major factor affecting its length is the urgency w/ which the surgery must be performed. |
| Inpatient surgery1 | term used for procedures performed on a pt who is admitted to the hospital, expected to remain @ least overnight & in need of nursing care more than 1 day after. |
| Advantages of laser surgery1 | cost effectiveness, reduced need for general anesthesia, smaller incisions, minimal blood loss. |
| Advantages of laser surgery2 | reduced swelling, less pain, decreased incidence of wound infections, reduced scarring, less time recuperating. |
| Informed consent | permission a pt gives after an explanation of the risks, benefits, and alternatives. |
| Criteria for informed consent1 | must be witnessed by nurse, if pt is confused, unconscious or mentally incompetent pt’s spouse, nearest blood relative, or some1 w/ dpoa for pt’s health care must sign. |
| Criteria for informed consent2 | if pt under influence of drugs/alcohol consent must be delayed. In life threatening emergency court may waive written/verbal consent if pt requires immediate surgery on basis of substituted judgment. |
| Substituted judgment | court believe if pt had capacity to consent he/she would have done so. |
| Criteria for informed consent3 | If pt is younger than 18 parent/legal guardian must sign, in emergency personnel must make effort by telephone, telegram, or fax to obtain consent, if pt lives on their own they may sign their own. |
| Nurse responsibility (informed consent)1 | must be familiar w/agency’s policies & state laws regarding surgical consent forms. Pt must sign b4 receiving any preoperative sedatives. |
| Nurse responsibility (informed consent)2 | for ensuring all necessary parties have signed consent form & it is in pt’s chart b4 pts goes to operating room. |
| Autologous transfusion | receiving one’s own blood, self donated blood. |
| Directed donors1 | blood donors chosen from among the pt’s relatives & friends. |
| Directed donors 2 | Pt siblings should not donate blood for pt, it later rules them out as future organ or tissue donors b/c of antigens in transfused blood would sensitize recipient, increasing risk for organ or tissue rejection. |
| Directed donors3 | Male sexual partner of woman in reproductive yrs should not be directed donor to avoid possible antibody reaction against a fetus in any future pregnancies. |
| Criteria for Autologous donation1 | Have Dr’s recommendation, have a hematocrit w/in safe range, be free of infection @ time of donation, meet blood centers minimum weight req’s. |
| Criteria for Autologous donation2 | Donate 40 to 3 days b4 anticipated date of use, donate no more frequently than every 3 to 5 days; once per wk is preferred. |
| Criteria for Autologous donation3 | Assume responsibility for costs about the usual processing fees even if blood is not used, be advised that his or her blood will be discarded if not used. |
| Criteria for directed donation1 | Be @ least 17 yrs old, meet all criteria of public donor, have same blood type as potential recipient or 1 that is compatible. |
| Criteria for directed donation2 | Not have received a blood transfusion w/in the last 6 mths, donate 20 to 3 days before the anticipated use, be free from blood borne pathogens & high-risk behaviors. |
| Major task 2 be done in immediate preoperative care | conducting nursing assessment, providing preoperative teaching, performing methods of physical preparation, administering medications, assisting w/ psychosocial preparation, & completing surgical checklist. |
| Nursing assessment responsibility1 | Nurse performs thorough history/physical exam also assess understanding of surgical procedure, postop expectations, & ability to participate in recover. |
| Nursing assessment responsibility2 | Considers cultural differences including influenced feelings on disposal of body parts & blood transfusions. Reviews preop instructions & id’s potential risks for complications. |
| Risk factors for periop complications1 | extremes of age, dehydration, malnutrition, obesity, smoking, diabetes, cardiopulmonary disease. |
| Risk factors for periop complications2 | drug & alcohol abuse, bleeding tendencies, low hemoglobin & red cells, & pregnancy. |
| Preop teaching | knowledge of what to expect on part of pt’s & family can enhance recovery from surgery. |
| Preop teaching includes1 | preop meds(when they are given & affects), postop pain control, explanation & description of postanesthesia recovery room or postsurgical area. |
| Preop teaching includes2 | discussion of freq of assessing vital signs, use of monitoring equipment, demonstrates how to perform deep breathing, coughing, & leg exercises. |
| Deep breathing1 | deep breathing, form of controlled ventilation that opens & fills small air passages in the lungs, advantageous for pts who receive general anesthesia or who breathe shallowly after surgery b/c of pain. |
| Deep breathing2 | reduces the postop risk for respiratory complications such as atelectasis & pneumonia, both can lead to hypoxemia. |
| Practicing breathing | Nurse practices deep breathing w/ pts b4 surgery. Involves using abd muscles holding breath for several seconds & exhaling slowly. |
| Spitometer | used to promote deep breathing. |
| Atelectasis | airless, collapsed lung areas. |
| Pneumonia | lung infection. |
| Coughing | a natural method for clearing secretions from the airways. Painful for pt’s w/ abd or chest incisions. Administering pain meds approx. 30 mins b4 coughing or splinting the incision during coughing can reduce discomfort. |
| Methods of splinting | pressing on the incision w/ hands, pressing on a pillow placed over the incision or wrapping a bath blanket around the pt. |
| Forced coughing | coughing that is purposely produced, most appropriate for pt’s who have diminished or moist lung sounds or who raise thick sputum. |
| How to perform force coughing | Sit upright, take a slow, deep breath through the nose, make the lower abd rise as much as possible, lean slightly forward, exhale slowly thru-the mouth, pull abd inward, repeat but this time cough 3 times in a row while exhaling. |
| Inpatient surgery2 | Many people who have inpatient surgery undergo prior laboratory & diagnostic test. |
| Anesthesiologist | physician who administers chemical agents that temporarily eliminate sensation & pain. |
| Anesthetist | nurse specialist who administers anesthesia under direction of physician. |
| Outpatient surgery(ambulatory surgery & same day surgery) | operative procedures performed on pts who return home the same day. |
| Outpatient surgical units | located in either hospital or separate building that the hospital owns. |
| Outpatient surgery | pt remains in outpatient surgical site for a brief time & is discharged by mid- afternoon or early evening when: pt is awake & alert, vital signs are stable, pain & nausea are controlled, oral fluids are retained, pt voids a sufficient quantity of urine, |
| Laser | stands for light amplification by the stimulated emission of radiation. Convert a solid gas, or liquid into light. When focused the energy from the light is converted to heat, causing vaporization of tissue & coagulation of blood vessels. |
| Ex of lasers | carbon dioxide laser, argon laser, ruby laser, & yttrium-aluminum-garnet(YAG) laser. |
| Leg exercises1 | help promote circulation & reduce risk for forming a thrombus. Blood clots form when venous circulation is sluggish & when fluid component of blood is reduced. |
| Thrombus | stationary blood clot in the veins. |
| Leg exercises2 | blood tends to pool in the lower extremities b/c of the stationary position during surgery & pt reluctance to move afterward. |
| Antiembolism stockings | knee high or thigh-high elastic stockings. Sometimes called thromboembolic disorder (TED) hose. |
| Antiembolism stockings help prevent | thrombi & emboli by compressing superficial veins & capillaries, redirecting more blood to larger & deeper veins, where it flows more effectively toward the heart. |
| Emboli | mobile blood clots |
| Reduce risk of forming thrombus by1 | Point toes toward mattress, then toward head, move both feet in clockwise & then counter-clockwise circles, sit w/head slightly raised, bend 1 knee. |
| Reduce risk of forming thrombus by 2 | Raise & hold leg above mattress for a few seconds, straighten raised leg, lower the leg back to bed gradually, do the same w/ other leg, repeat exercises 5 times @ least every 2 hours while awake. |
| Preop med1(anticholinergics) | such as glycopyrrolate (Robinul), decrease respiratory secretions, dry mucous membranes, & prevent vagal nerve stimulation during endotracheal intubation. |
| Preop med2 (antianxiety drugs) | such as lorazepam (Ativan), reduce preop anxiety cause slight sedation, slow motor activity, & promote the induction of anesthesia. |
| Preop med3 (Histamine-2 receptor antagonists) | such as cimetidine (Tagamet), decrease gastric acidity & volume. |
| Preop med4 (Narcotics) | such as meperidine (Demerol), decrease the amt of anesthesia needed & sedate the pt. |
| Preop med5 (Sedatives) | such as midazolam (Versed), promote sleep or conscious sedation & ` |
| Preop med6 (Antibiotics) | such as kanamycin (Kantrex), destroy enteric microorganisms. |
| Preoperative list | a form that identifies the status of essential presurgical activities & is completed before surgery. Nurse verifies preop list1 |
| Nurse verifies preop list2 | surgical consent form has been signed/witnessed, all lab test results have been returned/reported if abnormal, pt wearing Id bracelet. |
| Nurse verifies preop list3 | allergies have been id, pt has npo since midnight or number of hours prescribed, skin prep has been completed, VS have been assessed/recorded. |
| Nurse verifies preop list4 | Nail polish, glasses, contact lenses, & hairpins removed, jewelry has been removed or wedding ring secured, pt wearing only hospital gown/hair cover. |
| Nurse verifies preop list5 | Dentures removed, pt has urinated, location of IV site, type of intravenous solution, & rate of infusion are id, prescribed preop med has been given. |
| Intraoperative period | time during which pt undergoes surgery. |
| 3 types of anesthesia | general, regional, & local anesthesia. |
| General anesthesia1 | acts on central nervous system to produce loss of sensation, reflexes, & consciousness. Commonly are administered via inhaled & intravenous routes. |
| General anesthesia2 | pt is monitored closely for effective breathing & oxygenation; effective circulatory status, including blood pressure & pulse w/in normal ranges; effective temp regulation & adequate fluid balance. |
| General anesthesia3 | recovery period brief or long, pt do not remember much about the initial recovery period. |
| Regional anesthesia1 | interferes w/ the conduction of sensory & motor nerve impulses to a specific area of the body. Pt experiences loss of sensation & decreased mobility to the specific anesthetized area but doesn’t lose consciousness. |
| Types of regional anesthesia | local & spinal anesthesia & epidural & peripheral nerve. |
| Advantage of regional anesthesia | decreased risk for respiratory, cardiac, & gastrointestinal complications. |
| Regional anesthesia2 | pt must be monitored for signs of allergic reactions, changes in VS & toxic reactions, also must protect the anesthetized area while sensation is absent b/c the pt is at risk for injury. |
| Conscious sedation | state in which pts are sedated, a state of relaxation & emotional comfort, but not unconscious. Can respond verbally & physically. |
| Conscious sedation2 | Free of pain, fear, & anxiety & can tolerate unpleasant diagnostic & short therapeutic surgical procedures, such as endoscopies or bone marrow aspiration, while maintaining independent cardiorespiratory function. Pt discharged shortly after the procedure |
| Intravenous route | used to administer meds that create conscious sedation, if other routes are used pt must have venous access for treatment of possible adverse effects such as hypoxemia & central nervous system depression. |
| Nurse responsibility for conscious sedation | ensuring pt safety & comfort during sedation rests w/ nurse directly involved in the pt’s care. |
| Reversal drugs | meds that counteract the effects of those used for conscious sedation, must be readily available in case the pt becomes overly sedation. |
| Ex of reversal drugs | naloxone(Narcan), the antagonist for opiates like morphine, & flumazenil (Romazicon), reverses antianxiety drugs like midazolam(Versed). |
| Postoperative period | begins after operative procedure is completed & pt is transported to an area to recover from anesthesia & ends when pt is discharged. |
| Postanesthesia care unit(PACU), also known as postanesthesia reacting(PAR) | room or recovery room area in surgical department where pts are intensively monitored. |
| Nurses responsibility of PACU | ensure safe recovery of surgical pts from anesthesia, prepare for the pt’s return. |
| Postoperative care | nursing care after surgery different during immediate postoperative period than it is later when pts are more stable. |
| Immediate postop care | 1st 24 hrs after surgery, nurses monitor pt for complications as they recover from anesthesia, once stable nurse prepares room for pts return & assessments of pt continue to minimize complications. |
| PACU nurse’s major responsibility | to ensure a patent airway, help maintain adequate circulation; prevent or assist w/ management of shock, maintain proper positions & function of drains, tubes & intravenous infusions, & detect evidence of any complications. |
| PACU nurse checks1 | level of consciousness, VS, effectiveness of respirations, presence or need for supplemental oxygen, condition of the wound & dressing, |
| PACU nurse checks2 | location of drains & drainage characteristics, location, type & rate of intravenous fluid, level of pain & need for analgesia, presence of urinary catheter & urine volume. |
| Fluid/oral fluids1 | withheld until surgical pt’s awake & free of nausea & vomiting, & bowel sounds are active, |
| Fluid/oral fluids2 | usually progress from clear liquid diet to a surgical soft diet unless complications develop. Nurses monitor fluid intake & output to ensure that pts are adequately hydrated. |
| Discharge instructions | directions for managing self care & medical follow up b4 pt leaves. |
| Common areas to address @ discharge1 | How to care for the incision site, signs of complications to report, what drugs to use to relieve pain, how to self-administer prescribed drugs, |
| Common areas to address @ discharge2 | when presurgical activity can be resumed, if & how much weight can be lifted, which foods to consume or avoid, when/where to return for a medical appt. |
| Airway occlusion | obstruction of throat;treatment tilt head/lift chin, insert an artificial airway. |
| Hemorrhage | severe, rapid blood loss;treatment control bleeding, administer intravenous fluid, replace blood. |
| Shock | Inadequate blood flow;treatment place pt in modified trendeleburg position, replace fluids, administer oxygen, give emergency drugs. |
| Pulmonary embolus | obstruction of circulation thru the lung as a result of wedged blood clot that began as a thrombus;treatment give oxygen, administer anticoagulant drugs. |
| Hypoxemia | inadequate oxygenation of blood;treatment give oxygen |
| Adynamic ileus | lack of bowel motility;treatment treat cause, give nothing by mouth, insert a nasogastric tube & connect to suction, administer IV fluid. |
| Urinary retention | Inability to void;treatment insert a catheter |
| Wound infection | proliferation of pathogens at or beneath the incision;treatment cleanse w/ antimicrobial agents, open/drain incision, administer antibiotics. |
| Dehiscence | separation of incision;treatment reinforce wound edges, apply a binder. |
| Evisceration | protrusion of abdominal organs thru separated wound;treatment cover w/wet dressing, reapproximate wound. |
| Nursing diagnosis1 | anxiety, deficient knowledge, fear, acute pain, impaired skin integrity, risk for infection, risk for deficient fluid volume, ineffective breathing pattern, |
| Nursing diagnosis2 | ineffective airway clearance, Risk for impaired gas exchange, disturbed body image, risk for ineffective therapeutic regimen management. |
| Gerontologic1 | chronic health concerns may be present in older adults & may increase complexity of both preop & postop periods. |
| Gerontologic 2 | According to Agency for Healthcare Research & Quality pts 65yrs & older account for 1 or every 3 hospital admissions. Mean length of stay for this age group is 1.7 days long than others. |
| Gerontologic 3 | Older adults rely on eyeglasses or hearing aids may experience sensory deprivation if these aids are removed before surgery or other procedures. Removal may interfere w/ communication or contribute to confusion & altered mental status. |
| Gerontologic 4 | less likely to be self-conscious when dentures are removed before surgery. Collaboration w/ operating room personnel regarding the removal of dentures, eyeglasses, & hearing aids is helpful to ensure their use as much or as long as possible. |
| Older adults rely on eyeglasses or hearing aids may experience sensory deprivation if these aids are removed before surgery or other procedures. Removal may interfere w/ communication or contribute to confusion & altered mental status. | |
| Gerontologic 4 | less likely to be self-conscious when dentures are removed before surgery. Collaboration w/ operating room personnel regarding the removal of dentures, eyeglasses, & hearing aids is helpful to ensure their use as much or as long as possible. |
Created by:
posiniv
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