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Perioperative: Sensr
ABCs, Maslow, perioperative phases, MH, PACU priorities
| Question | Answer |
|---|---|
| Phases of Perioperative Care | Preoperative: assessment, education, risk reduction Intraoperative: safety, asepsis, anesthesia, positioning Postoperative (PACU): airway, breathing, circulation, pain, temperature 🧠 Memory: Pre = prepare | Intra = protect | Post = recover |
| Key Preoperative Assessments | Medications & allergies Nutritional/fluid status Respiratory & cardiovascular status Renal/hepatic/endocrine function Psychosocial factors 🧠 Exam tip: Always assess kidneys + lungs before surgery |
| Preoperative Teaching Topics | Deep breathing & coughing Incentive spirometer Early ambulation Pain management plan NPO status 🧠 NCLEX: Teaching happens before surgery, not after anesthesia |
| Roles of the Surgical Team | Surgeon: performs procedure Anesthesiologist/CRNA: anesthesia & airway Scrub nurse/tech: sterile field Circulating nurse: safety, consent, documentation, positioning 🧠 Key: Circulator = patient advocate |
| Malignant Hyperthermia (MH) | Rare, inherited reaction to anesthesia Triggered by inhaled anesthetics & muscle relaxants Causes rapid hyperthermia, muscle rigidity, ↑ CO₂ 🧠 Life-threatening emergency |
| Treatment for Malignant Hyperthermia | Stop anesthesia Administer dantrolene Cool patient 100% oxygen Monitor labs & ECG 🧠 Exam: Dantrolene is the antidote |
| PACU Priorities | Airway & oxygenation Level of consciousness Vital signs Pain control Temperature regulation Surgical site assessment 🧠 Order: ABCs before comfort |
| Postoperative Pain Management | Opioids (IV, PCA) Multimodal analgesia Nonpharmacologic methods (positioning, ice, relaxation) 🧠 Pain control improves breathing & mobility |
| Thermoregulation Issues Post-Op | Hypothermia (MOST common) Malignant hyperthermia (rare but deadly) 🧠 Cold patient = higher infection risk |
| A postoperative patient arrives in PACU with shallow respirations and O₂ sat of 88%. What is the nurse’s priority action? | A. Assess pain B. Encourage incentive spirometer C. Apply oxygen D. Check temperature ✅ Answer: C — Apply oxygen Rationale: Breathing comes before pain or teaching (ABCs). |
| Which finding is most concerning for malignant hyperthermia? | A. Shivering B. Muscle rigidity and rising temperature C. Hypotension D. Nausea and vomiting ✅ Answer: B Rationale: MH causes muscle rigidity, hyperthermia, ↑ CO₂. |
| Which task is the responsibility of the circulating nurse? | A. Passing sterile instruments B. Administering anesthesia C. Verifying consent and maintaining safety D. Closing the surgical incision ✅ Answer: C |
| Which intervention best prevents postoperative atelectasis? | A. Pain medication B. Incentive spirometer use C. Bed rest D. Oxygen by mask ✅ Answer: B |
| A patient is anxious preoperatively. Which nursing action best supports sensory perception and comfort? | A. Delay surgery B. Provide education and reassurance C. Administer anesthesia early D. Restrict family presence ✅ Answer: B |
| Postoperative Respiratory Complications | Atelectasis Pneumonia Hypoxemia Respiratory depression (opioids) 🧠 Prevention: IS, TCDB, early ambulation |
| What is AKI? | Sudden ↓ kidney function ↓ GFR ↑ creatinine & BUN Often reversible 🧠 Think: “Acute = sudden” |
| 3 Types of AKI | Prerenal: ↓ perfusion Intrarenal: kidney damage Postrenal: obstruction 🧠 Memory: Pre → In → Post |
| Causes of Prerenal AKI | Dehydration Hemorrhage Shock Heart failure 🧠 Key: Blood flow problem |
| Causes of Intrarenal AKI | Nephrotoxic drugs Infection Prolonged ischemia Glomerulonephritis 🧠 Key: Kidney tissue damage |
| Causes of Postrenal AKI | BPH Kidney stones Tumors Obstruction 🧠 Key: Flow OUT is blocked |
| Key Assessment Findings in AKI | ↓ urine output (<30 mL/hr) Edema Fatigue Confusion Crackles 🧠 Red flag: Low urine = low perfusion |
| AKI Lab Findings | ↑ Creatinine (MOST important) ↑ BUN ↑ Potassium Metabolic acidosis 🧠 Exam: Creatinine > BUN |
| Most Dangerous AKI Complication | Hyperkalemia → dysrhythmias 🧠 Memory: K⁺ kills first |
| Priority Nursing Actions for AKI | Strict I&O Daily weights Monitor labs Avoid nephrotoxins Manage fluids carefully 🧠 ABCs: Circulation priority |
| When to Suspect Worsening AKI | Rising creatinine Decreasing urine output Fluid overload ECG changes |
| EXAM MEMORY LOCKS | AKI = creatinine problem Low urine = low perfusion Hyperkalemia is deadly Prerenal is most common |
| What is a GI Bleed? | Bleeding anywhere in GI tract Can be upper or lower Causes hypovolemia & anemia 🧠 Priority: Circulation |
| Upper vs Lower GI Bleed | Upper: esophagus, stomach, duodenum Lower: colon, rectum, anus 🧠 Upper bleeds are usually more serious |
| Signs of Upper GI Bleed | Hematemesis (coffee-ground emesis) Melena (black, tarry stools) ↑ BUN Hypotension, tachycardia 🧠 Melena = upper GI |
| Signs of Lower GI Bleed | Hematochezia (bright red blood) Rectal bleeding Less severe VS changes (often) |
| What are Esophageal Varices? | Dilated veins in esophagus Caused by portal hypertension Common in cirrhosis 🧠 High risk for massive bleeding |
| Priority Care for Esophageal Varices | 2 large-bore IVs NPO IV octreotide IV PPI Prepare for endoscopy/banding 🚫 NO NG tube (rupture risk) |
| Causes of Peptic Ulcer Disease | H. pylori NSAIDs Stress Smoking |
| PUD Bleeding Signs | Epigastric pain Hematemesis Melena ↓ Hgb/Hct 🧠 Pain may decrease when bleeding starts |
| PUD Treatment | Proton pump inhibitors (pantoprazole) Antibiotics (H. pylori) Avoid NSAIDs |
| What are Hemorrhoids | Swollen rectal veins Internal or external NOT life-threatening |
| Hemorrhoid Bleeding Features | Bright red blood On toilet paper or stool No hypotension No anemia (usually) 🧠 Benign compared to other GI bleeds |
| Hemorrhoid Management | Stool softeners Fiber & fluids Topical treatments Avoid straining |
| 🧠 EXAM MEMORY LOCKS | GI bleed = circulation problem Varices = NO NG tube Melena = upper GI Bright red blood = hemorrhoids or lower GI Octreotide = varices PPI = ulcers |
Created by:
Anmag002
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