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medsurg
periop nursing pt 1
| Question | Answer |
|---|---|
| three phases of perioperative nursing | pre, intra, post |
| pre op | when the pt decides to have surgery to the time they are on the table |
| intra op | when the pt enters the OR to the time they go to the PACU |
| post op | when the pt enters the PACU to when they are in follow ups and are released from care |
| surgical classifications | emergent, urgent, required, elective, optional |
| emergent surgery | without delay, requires immediate attention ex: traumas, aneurysm - level 1 trauma |
| urgent surgery | pt needs prompt attention, within 24-38 hrs ex: kidney stones, fracture, drainage |
| required surgery | needs the surgery done because can cause other issues but can be done in weeks to months ex: masses in breasts, lesions, thyroid disorders |
| elective surgery | should have, not catastrophic if not ex: hernia repair, vaginal repair, cysts, lypomas |
| optional surgery | cosmetic |
| informed consent is | necessary for all nonemergent surgical procedures |
| when is informed consent not needed | if the procedure is life saving and the pt can't sign or get ahold of the caregiver |
| who is consent gotten by | physician, not RN |
| Criteria for Valid Informed Consent | Voluntary consent Freely given, without coercion Informed Subject Patient Able to Comprehend |
| an informed subject | Explain procedure, risks, benefits Offer to answer questions Can refuse (consequences) |
| if pt is unable to comprehend | power of attorney or family member |
| if pt is a minor | parent |
| preparation for surgery | Complete history and physical several points of emphasis |
| several points of emphasis for surgery prep | Adverse anesthesia effects Medications (prescribed, OTC, discontinued) Allergies (latex) PMHx (risk status) PSHx Substance abuse (reaction to analgesics, withdrawal) Nutritional status (healing, recovery, obesity) |
| Medications (prescribed, OTC, discontinued) | herbal: can cause coagulation and lethal drug interaction aspirin: up to physician discretion, takes 7-10 days to get out OTC: switch from warfarin to heparin for surgery discontinued: 2-3 weeks prior |
| allergies | latex: be the first pt in the OR that day! iodine contrast dye: shellfish allergy could be an indicator |
| nutritional status | albumin level needs to be appropriate for recovery obesity can cause a longer recovery especially for abd surgery |
| Preoperative Diagnostic Testing | Confirm completed and all results available Specific testing re existing disease processes - liver, comorbidites many common tests |
| common test for pre op dx testing | CBC, Electrolytes, UA EKG Chest X-ray Type and Screen / Type and Cross Pregnancy test (urine or blood) |
| chest xray pre op for | any pulmonary diseases |
| pregnancy test done to and because | anyone pre menopause or without a hysterectomy anesthetics are harmful to fetus |
| blood products | a written consent to administer Can be part of surgical consent but are in a separate section |
| blood products need their order confirmed as | Type and screen Type and cross |
| Type and screen = | required when not likely to require transfusion |
| Type and cross = | required when potential for blood loss is high - trauma or open heart |
| if type and cross, then | check # of units of PRBC available so that the blood is ready to go |
| Preoperative Patient Teaching is key to | better postoperative outcomes |
| Deep Breathing/ Coughing steps | Sitting position - as far as possible or in chair Splint incision - thoracic or abd surg should hold pillow there Deep breaths x 3-4 - in thru nose, out thru mouth Quick deep breath Strong cough |
| how often should a pt repeat Deep Breathing/ Coughing steps | 3x or every hour when pt is awake unless contraindicated due to procedure type |
| incentive spirometer is looking for | inspiratory volume |
| teaching pts to use incentive spirometer | Sit edge bed or raise HOB as far as poss Mouthpiece in mouth, seal lips Breathe in as slowly and deeply as poss Raise piston to yellow indicator Hold breath 5 sec Let piston fall repeat 10x when awake |
| Use yellow indicator to indicate | best effort |
| After 10 breaths | cough while splinting incision |
| foot exercises | Point toes to head of bed Point toes to foot of bed Repeat five times each foot |
| doing foot/ankle exercises prevents | venous stasis |
| leg exercises | Bed leg at knee and raise it toward chest Straighten leg and hold it for a few seconds Lower leg Repeat 5x with each leg q1 if poss |
| ankle exercises | Rotate both ankles making a complete circle Circle to the right them circle to the left Repeat 5x |
| SCD and TED hose | Sequential Compression Devices |
| SCD and TED hose are to | prevent DVT |
| how do SCD and TED hose work | inflate like a BP cuff on calf and mimic calf contraction to get blood from legs to move because when the blood stays still it will clot, make sure to position correctly to help push fluid out of veins |
| when to not use SCD and TED hose | when pt already has a clot in their leg bc can dislodge the clot and cause an embolism |
| explaining Mobility, Turning and Positioning to pt | important for early mobility and turning to help prevent skin breakdown and atrophy, and increase blood flow also helps with respiratory function, GIT and decreasing DVT |
| Mobility, Turning and Positioning unless | contraindicated due to surgical procedure |
| Mobility, Turning and Positioning when? | OOB day of surgery or 1st postoperative day |
| important to use/educate on | any assistive devices to promote mobility any immobilization devices to promote alignment of extremity role of physical therapy if ordered |
| overbed trapeze | used to help pt pull up in bed |
| abductor pillow | used for pts with total hip replacements to keep hips in alignment, decreases DVT and LOS |
| post op drains education | Explain anticipated drains to patient Explain purpose of drains Provide literature with illustrations |
| nasogastric tube (NG) | used for GI surgery and want to rest stomach and GIT keeps the GI system at rest |
| nasogastric tube (NG) kept until | bowel sounds are heard and pt can pass gas |
| chest tube to underwater seal drain | tube inserted into pleural space to drain until the bleeding subsides |
| pinrose drain | used if you don't want to close the surgical site, ex: if there was an abscess |
| hemovac, jp drain | allows escape of fluids from site and suction is maintained by bulb (jp) |
| drainage = | I+O! |
| pain management teaching | Teaching pain communication skills preoperatively results in greater pain relief Explain use of pain scale preoperatively Instruct patient to ask for pain medication as frequently as needed for pain relief |
| when assessing pain, | remember pain is subjective ask the pt what an acceptable pain level is |
| regional pain pumps | catheter is inserted into surgical site and gives a continuous dose of med to relieve pain |
| PCA pump aka | patient controlled analgesia |
| PCA pumps are touched by | pt not RN or family member |
| PCA pump guides are written by | surgeon |
| PCA pump are only used if | pt is cognicent enough to give med and if not RN needs an order to give med themself |
| how does a PCA pump work | syringe is filled with drug and there are preset guides with how much to give and a total in the syringe, pump calculates dose and time, locks out until the time frame hits again |
| when a pt is using a PCA pump, monitor | respiratory distress bc CO2 could decrease meaning OD |
Created by:
leh195