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periop nursing 2
med surg exam 1
| Question | Answer |
|---|---|
| Psychological Support of
Patient and Family | Preoperative teaching Explain what will occur the day of surgery Listen to concerns and fears of patient and family members Offer to contact spiritual advisor |
| what does preoperative teaching help do? | decrease anxiety |
| PO Restrictions Prior To Surgery | Traditionally NPO after midnight if AM surgery May be ordered medications sip water No gum or hard candy *explain why NPO to pt |
| what are PO restrictions prior to surgery done to promote? | gastric emptying and decrease risk of aspiration |
| Fasting Period for healthy patients of all ages undergoing elective surgery (not including women in labor)- Clear liquids | 2 hours (e.g. water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee) |
| Fasting Period for healthy patients of all ages undergoing elective surgery (not including women in labor)- Breast milk | 4 hours |
| Fasting Period for healthy patients of all ages undergoing elective surgery (not including women in labor)- infant formula | 6 hours |
| Fasting Period for healthy patients of all ages undergoing elective surgery (not including women in labor)- nonhuman milk | 6 hours (amount needs to be considered) |
| Fasting Period for healthy patients of all ages undergoing elective surgery (not including women in labor)- light meal | 6 hours (e.g. toast and clear liquids) |
| Fasting Period for healthy patients of all ages undergoing elective surgery (not including women in labor)- Meals that include fried, fatty food, meats | 8 hours |
| day of surgery | preop checklist complete baseline VS pt has ID, allergy wrist band pt wearing gown, no underwear, nail polish, makeup, jewelry, dentures, bridges, glasses, hearing aids unless needs them to comm. with anesthesia/OR prior to anest. pt void prior to OR |
| why don't we allow pts to wear jewelry in OR? | cautery intrument |
| why might anesthesia want dentures and bridges in? | so they can get a better fit of the mask |
| preoperative meducation may be ordered? | "on call for OR" |
| preoperative medication is used to relieve? | anxiety and facilitate anesthesia |
| what to do if preop medication is ordered that effects cognitive ability? | make sure surgical and anesthesia consents are signed prior to administration |
| what may be given preop to prevent nausea from anesthesia? | antiemetic |
| what may be ordered prior to eye surgery? | eye drops- typically to dilate eye |
| upon arrival to holding area the patient is? | check in by preop holding area nurse |
| how many identifiers are used in pre-op holding area to identify patient? | two identifiers |
| preop holding area nurse gets verification of? | correct person, correct site, correct procedure |
| The Joint Commission 
Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery- requirements | pre-procedure verification, mark the procedure site, time out |
| In 2004- Pennsylvania Patient Safety Authority initiated? | mandatory wrong-site surgery reporting |
| three zones in the OR | unrestricted, semi-restricted, restricted |
| unrestricted zone in the OR | can wear street clothes |
| semi-restricted zone in the OR | must wear scrubs and a surgical hat |
| restricted zone in the OR | must wear scrubs, surgical hat and mask |
| surgical team | 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 |
| spinal anesthesia | local anesthesia to subarachnoid space, pt becomes paralyzed |
| how long does spinal anesthesia typically work? | 2-3 hours |
| Spinal anesthesia increases incidence of? | hypotension |
| auxiliary block | done for pain control, arm numb from block down, monitor extremely close to prevent damage |
| positioning of patients is dependent on? | surgery- important consideration |
| how to avoid complications that can be caused by positioning patients | Prevent hyperextension of extremities Prevent pressure on nerve Present circulation occlusion Padding to prevent pressure ulcers |
| types of patient positioning | Supine Prone Lateral Lithotomy |
| crutchfield tongs | go into brain to provide full access, immobolize and align the spine |
| what is performed before starting the procedure? | time-out |
| time-out characteristics | Standardized throughout the hospital Initiated by a designated mem. of the team Involves all the immediate mems. and interactive verbal between all Anyone can express concerns abt procedure verif. defined process for reconciling diff in response. |
| during the time out all other activities are? | suspended |
| laparoscopic (minimally invasive) surgery | don't make a big cut-> faster recovery |
| da vinci surgical system | takes a lot of training, robotic system |
| who counts the surgical instruments, sponges needles and sharps | circulating nurse and tech |
| sponge count technology | radio-frequency identification (RFID) |
| prevention of deep vein thrombosis | sequential compression devices (SCD) |
| 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 |
| post anesthesia recovery room (PACU) assessment | ABC- Airway, Breathing, Cardiovascular LOC Vital Signs Drains Dressings Fluids Pain Nausea |
| nursing care in pacu | Assessing the patient Maintaining a Patent Airway Maintaining Cardiovascular Stability Pain Relief |
| nursing care: readiness for PACU discharge | Stable vital signs, pain controlled Other dependent on type of surgery |
Created by:
camrynfoster