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medsurg
periop nursing pt 2
| Question | Answer |
|---|---|
| PO Restrictions Prior To Surgery | Traditionally NPO after midnight if AM surgery: may be ordered medications sip water No gum or hard candy |
| what are PO Restrictions Prior To Surgery done to | promote gastric emptying and decrease risk of aspiration |
| day of surgery | Confirm preoperative checklist completed Record baseline Vital Signs Check patient has ID and allergy wrist band on Patient is to wear hospital gown, no underwear |
| pt needs to remove these things on day of surgery | Remove nail polish, makeup, all jewelry Remove dentures and bridges Remove eyeglasses, hearing aids unless patient needs them to communicate with anesthesia/OR personnel prior to anesthesia |
| pt should | voide prior to leaving for OR |
| pre op medication may be | ordered “on call for OR” Used to relieve anxiety and facilitate anesthesia given to prevent nausea from anesthesia (antiemetic) eye drops order prior to surgery |
| If medication is ordered that effects cognitive ability | make sure surgical and anesthesia consents are signed prior to administration |
| pt in pre op holding area: upon arrival | pt is checked in by pre op holding area nurse using two pt identifiers, verification of correct person, correct site, correct procedure |
| The Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery | Pre-procedure verification Mark the Procedure Site Time Out |
| three zones in the OR | unrestricted, semi-restricted, restricted |
| unrestricted | can wear street clothes |
| semi-restricted | must wear scrubs and surgical hat |
| restricted | must wear scrubs, surgical hat and mask |
| surgical team consists of | Surgeon Resident or fellow Anesthesiologist Nurse anesthetist Circulating Nurse Surgical technician |
| types of Anesthesia | general, regional, local |
| general Anesthesia | inhalation, monitored Anesthesia care (MAC) AKA conscious sedation, IV sedation |
| regional Anesthesia | epidural, spinal |
| local Anesthesia | blocks |
| positioning of pt is dependent on | surgery |
| do these things when positioning a pt to prevent complications | Prevent hyperextension of extremities Prevent pressure on nerve Present circulation occlusion Padding to prevent pressure ulcers |
| types of positions | Supine - back Prone - stomach Lateral Lithotomy |
| Patient Having Brain Surgery Head Suspended with | Crutchfield Tongs, go into skull for full access to brain |
| performing a time out | prior the starting the procedure |
| time out has the following characteristics | same for whole hospital Initiated by a designated member Involves all the immediate members of team Involves verbal btwn all team Has a defined process for reconciling differences in response |
| time out allows a team member to | express concerns about procedure verification |
| during a time out | all other activities are suspended to ensure correct pt, procedure and sight |
| Laparoscopic Surgery | Minimally Invasive, uses scope, much faster recovery |
| a liver transplant is | time coordinated |
| Surgical Instrument, Sponges, Needles and Sharps need a | count!! |
| any thing that has a chance of being left in the pt needs a | count |
| counts are done by | surgical tech and circulating nurse |
| if a count is not correct then, | do xray to see what is missing and where it is |
| Sponge Count Technology: Radio-Frequency Identification (RFID) | put the disc over the pt and will lyk where the sponge is |
| Prevention of Deep Vein Thrombosis | Sequential Compression Devices (SCD) applied |
| Sequential Compression Devices (SCD) applied to | all patients receiving general anesthesia prior to induction |
| Surgical Site Infection Prevention | Maintain normal body temperature Maintain normal glucose levels Do not shave surgical site Prophylactic antibiotic therapy |
| Maintain normal body temperature is important | to keep pt warm since the OR is cold and opening the abd makes pt cold as well |
| Prophylactic antibiotic therapy | pt is given IV dose of abx and followed post op for abt 24 hrs to decrease chance of infection |
| Post Anesthesia Recovery Room (PACU) Assessment | ABC LOC Vital Signs Drains - putting out what? Dressings - monitor Fluids Nausea and pain - kept under control |
| ABC | Airway - important!! until wake enough to breathe on their own Breathing Cardiovascular |
| nursing care in the PACU | Assessing the patient ***Maintaining a Patent Airway*** Maintaining Cardiovascular Stability Pain Relief |
| Readiness for PACU Discharge | Stable vital signs, pain controlled Other dependent on type of surgery |
Created by:
leh195