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perioperative nursin
med surg exam 1
| Question | Answer |
|---|---|
| preoperative | time from which patient decides to have surgery to when they are on the OR table |
| intraoperative | time the patient is on OR table to when they are in the PACU |
| postoperative | time patient in PACU to the follow up visit with their doctor and released from their care |
| surgical classifications (based on urgency) | emergent, urgent, required, elective, optional |
| emergent surgery | immediate attention needed (trauma)-> need surgery right away |
| level 1 trauma center | need staff and OR room ready at all times |
| hospitals without a level 1 trauma center | surgeon on call must be available within 30 minutes |
| urgent surgery | patient needs prompt attention within 24-30 hours; quickly but with time still |
| examples of urgent surgery | kidney stones, infections, fractures) |
| required surgery | needs surgery done, but within weeks to months so it does not progress |
| examples of required surgery | enlarged prostate, thyroid issues |
| elective surgery | patient should have, but if they don't its not catastrophic |
| examples of elective surgery | hernia, cyst, lipoma |
| examples of optional surgery | cosmetic surgery |
| informed consent | necessary for all non-emergent surgical procedures |
| when can you do a surgery without informed consent? | if patients can't sign and can't get a hold of family and it is required to save their life |
| what does informed consent protect? | physician and patient |
| criteria for valid informed consent | voluntary consent; freely given, without coercion; informed subject; patient able to comprehend |
| criteria for valid informed consent- informed subject | explain procedure, risks, benefits; offer to answer questions; can refuse (consequences) |
| criteria for valid informed consent- patient able to comprehend | if unable to comprehend or minor (parent may be able to sign), state regulations differ |
| preparation for surgery | complete history and physical |
| points of emphasis before surgery | Adverse anesthesia effects Medications (prescribed, OTC, discontinued) Allergies (latex) Past medical history (risk status) Past surgical history Substance abuse (reaction to analgesics, withdrawal) Nutritional status (healing, recovery, obesity) |
| if patient before surgery is on warfarin what should you look at? | INR-> get to normal levels before surgery |
| if a pt is allergic to latex when should their procedure be done? | first case of the day |
| if a pt is allergic to shellfish what could that be an indication of? | allergies to iodine |
| nutritional status of pt before surgery | look at their albumin, obese patients take longer to heal |
| preoperative diagnostic surgery | Confirm completed and all results available Common Tests Specific testing re existing disease processes |
| common preoperative diagnostic tests | CBC, Electrolytes, UA EKG Chest X-ray Type and Screen / Type and Cross Pregnancy test (urine or blood |
| type and screen test | done when patient is not likely to need, no blood is crossmatched |
| type and cross test | requested when potential for blood loss increases, physician requests cross match for x amounts of units |
| administering blood products | Need a written consent to administer Can be part of surgical consent-Separate section Confirm ordered Type and screen = Type and cross = (If type and cross check # units PRBC available) |
| what type of blood can you administer as a student? | none! can do vital signs |
| preoperative patient teaching is key to? | better postop outcomes |
| preoperative patient teaching | most patients come to the hospital the morning of surgery-> done post op a lot of times |
| deep breathing/ coughing steps | Sitting position Splint incision Deep breaths x 3 Quick deep breath Strong cough Repeat X 3 |
| what is deep breathing/ coughing used for? | to improve lungs and elimination of mucus from airway |
| how often is deep breathing/ coughing done? | every hour when the patient is awake |
| teaching patients to use the incentive spirometer | Sit edge bed or raise HOB Place mouthpiece, seal lips Breathe in slowly & deeply Raise piston to yell. indic. Hold breath 5 sec Allow to fall Repeat 10/hr while awake. Use yellow indic. to indic. best effort. After 10, cough, splinting incision |
| when do you teach patients to breath as slowly in as possible? | slow breathing opens airways better |
| foot exercises | Point toes to head of bed. Point toes to foot of bed Repeat five times each foot |
| what do foot exercises help prevent? | venous stasis in legs |
| how do foot exercises help? | veins have 1 way valve, when calf muscle contracts it pushes blood to center of body |
| leg exercises | Bed leg at knee and raise it toward chest Straighten leg and hold it for a few seconds Lower leg Repeat five times with each leg (every hour) |
| ankle exercises | Rotate both ankles making a complete circle Circle to the right them circle to the left Repeat five times |
| what do ankle exercises help prevent? | venous stasis |
| sequential compression devices and TED hose | inflate on calf muscle and mimic contraction to get blood flow out of legs to prevent DVT |
| when using sequential compression devices and TED hose make sure? | bladder is in the back |
| what to explain to the patient regarding mobility, turning and positioning? | rationale for early mobility and turning; unless contraindicated due to surgery, OOB day of surgery or 1 postop day; any assistive devices to promote mobility;any immbolization devices to promote alignment of extremity, role of physical therapy if ordered |
| rational for early mobility and turning | helps with respiratory status- clears lungs; gets GI tract moving |
| mobility assistive devices | overbed trapeze, walker, abductor pillow |
| abductor pillow is usually used for? | patients with total hip replacement |
| postop drains | Explain anticipated drains to patient Explain purpose of drains Provide literature with illustrations |
| nasogastric tube | put tube in stomach and suctions to keep GI system at rest |
| chest tube to underwater seal drain | drains until no longer bleeding in pleural space |
| postop drains | JP drains, hemovac, pen rose drain |
| JP drain | on surgical site connected to wound, suctions, closed system |
| pen rose drains | open system, drains but bacteria can get in, used if you don't want wound closed because of abscess etc. |
| teaching pain communication skill preoperatively results in? | greater pain relief |
| patient teaching for pain management | Teaching pain communication skills Explain use of pain scale preoperatively Instruct patient to ask for pain medication as frequently as needed for pain relief |
| PCA pump (patient-controlled analgesia) | filled with dilaudid or morphine, pre set guide to how much they can give themself; pt gives themself a dose and then it locks until the time set on the monitor |
| what to be aware of when using a PCA | patients mental status change, make sure they are cognitively able to do it-> if not find another way to give |
| regional pain pumps | long acting lidocaine-> continuous dose to help with pain relief |
Created by:
camrynfoster