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perioperative Nurs 2

Perioperative Fundamentals ch 50 test one

Ambulatory surgery centers also referred to as outpatient surgery, short-stay surgery, same day surgery.
laparoscopic surgery involves the use of minimally invasive techniques such as small incisions for performance of the surgery as opposed to large incision surgery.
Association of Operating Room Nurses was formed to gain knowledge of surgical principles and explore methods to improve nursing care of surgical clients.
perioperative nursing is nursing care given before(preoperative), during(intraoperative), and after surgery(postoperative.
assessment aim is to establish the client's before surgery is to establish preoperative function and minimize possible postoperative complications
Nursing History Initial interview to collect client history.
Medical History a review of the client's medical history includes past illnesses and surgeries and the primary reason for seeking medical care.
risk factor; age very young and very old are at risk during surgery because of immature or declining physiological status. Mortality is higher at these stages.
risk factor; nutrition normal tissue repair and resistance to infection depend on adequate nutrients. surgery intensifies this need. surgical clients need 1500 k/cal/day to maintain energy
risk factor: obesity obesity increases surgical risk by reducing ventilatory and cardiac function
bariatric obese
atelectasis is the collapses of all or part of the aveoli resulting in reduced or absent gas exchange.
risk factor: obstructive sleep apnea is a syndrome of periodic, partial or complete obstruction of upper airway, partial or complete obstruction of the upper airway during sleep.
risk factor: immunocompromise client with cancer, bone marrow alterations, can occur, and increase the risk of infection.
risk factor: fluid and electrolyte imbalance the body responds to surgery as a form of trauma. sever protein breakdown causes a negative nitrogen balance and an elevation in blood glucose levels which decrease tissue healing and increase risk of infection
risk factor: pregnancy the perioperative plan of care addresses not one but two clients the mother and child. the pregnant client has surgery only on an emergent or urgent basis.
medication with special indications in surgery Antibiotics antibiotics enhance action of anesthetic agents. if taken within 2 weeks may cause mild respiratory depression.
medication with special indication in surgery antidysrhythmics can reduce cardiac contractility and impair cardiac conduction during anesthesia
medication with special indication in surgery anticoagulants such as warfarin, alter normal clotting factors and thus increase risk of hemorrhaging. decrease at least 48 hours before surgery
medication with special indication in surgery anticonvulsants long-term use of certain anticonvulsants alters metabolism of anesthetic agents.
medications with special indication in surgery antihypertensives such as beta blockers and calcium channel blockers, interact with anesthetic to cause bradycardia, hypotension and impaired circulation
medications with special indication in surgery corticosteroids with prolonged use , corticosteroids such as prednisione, cause adrenal atrophy, which reduces the body's ability to withstand stress. before and after surgery dosage increased
medications with special indication in surgery insuling clients' need for insulin changes after surgery. stress response and intravenous administration of glucose solutions often increase dosage requirements
medications with special indication in surgery diuretics diuretics such as furosemide potentiate electrolyte imbalances particularly potassium after surgery.
medications with special indication in surgery nonsteroidal antiiflammatory drugs NSAIDS inhibit platelet aggregation and prolong bleeding time, increasing susceptibility to postoperative bleeding.
medications with special indication in surgery Herbal therapies ginger, gingko, ginseng these herbal therapies have the ability to affect platelet activity and increase susceptibility to postoperative bleeding. Ginseng is reported to increase hypoglycemia.
perceptions and knowledge regarding surgery Assess client's previous experiences with surgery as a foundation for teaching, addressing fears, and clarifying concerns. ask the client to discuss the previous type of surgery, level of discomfort, extent of disability, and overall level of care needed
medication history if a client regularly uses prescription or over-the-counter medications, the surgeon or anesthesia provider may temporarily discontinue the drugs before surgery or adjust dosages.
allergies assess for allergies to drugs that clients receive during the perioperative period. latex allergies-latex-free surgical environment. types of allergic reactions.
smoking habits the client who smokes is at greater risk for postoperative pulmonary complications. mucous secretion are increased. general anesthetics increase airway irritation and stimulate pulmonary secretions.
alcohol ingestion and substance abuse habitual use of alcohol and illegal drugs predisposes the client to adverse reactions to anesthetics
support sources it is important to determine the extent of the clients support from family memebers or friends.
occupation surgery sometimes results in physical alterations that prevent a person from returning to work
preoperative pain assessment surgical manipulation of tissues, treatments and positioning on the operating room table may result in postoperative pain for the client.
emotional health surgery is psychologically stressful. clients are often anxious about the surgery and its implications and feel powerless. if client feels powerless attempt to find reason
self-concept clients with a positive self concept are mor likely to approach surgical experiences appropriately. assess self concept by asking clients to identify personal strengths and weaknesses.
body image surgical removal of any disease body part often leaves permanent,alteration in body function, or concern over mutilation
coping resources assessment of feelings and self concept reveals whether the client is able to cope with the stress of surgery. ask past stress management.
culture culture is system of beliefs developed over time and passed on through many generations. clients have a diverse background with religion, ethnic, and religious.
client expectations individualize each plan of care for each client, including client expectations
physical examination: general survey observe the client's general appearance. gestures and body movements may reflect weakness caused by illness. assess the client for a malnourished appearance. height, body weight, and history of recent weight loss. preoperative vital signs for baseline
physical examination: head and neck the condition of oral mucous membranes is one indicator of hydration. inspect jugular veins for distention.
physical examination: integument inspect skin, especially bony prominences; client lies still for hours during surgery. skin alteration a problem
physical examination:thorax and lungs assessment of the client's breathing pattern and chest excursion measure ventilatory capacity, a decline puts at risk for respiratory complications.
physical examination:heart and vascular system assess the character of the apical pulse and listen to heart sounds. assess peripheral pulses, cap refill and the color and temp of extremities.
physical examination: abdomen assess the abdomen for size, shape, symmetry, and presence of distention. ask whether the client has regular bowel movements, and inquire about the color and consistency of stools
physical examination: neurological status preoperative assessment of neurological status is imperative for all clients getting anesthesia. LOC,alertness and mood.
Nursing diagnosises ineffective airway clearance, anxiety, fear, risk for deficient fluid volume, risk for perioperative positioning injury, deficient knowledge, impaired physical mobility, nausea, acute pain, delayed surgical recovery.
preoperative teaching knowledge pertaining to adult learning principles, couple with the client's unique needs
Planning requires the involvement of surgical client and family in establishing plan of care.
goals and outcomes client verbalizes prevention of lung congestion and pneumonia as reasons for deep breathing and coughing exercises and incentive spirometer.
setting priorities using clinical judgement, prioritize nursing diagnoses and interventions based on the assessed unique needs of each client
collaborative care well planned preoperative care ensures that the client is well informed and able to be active participant in recovery
informed consent surgery cannot be legally or ethically performed until client understands the need for a procedure, the steps involved, risks, expected results, and alternative treatments
health promotion activities during the preoperative phase focus on health maintenance, prevention of complications, and support of possible rehabilitation needs postoperatively.
preoperative teaching provided in a systematic and structured format with teaching and learning principles, preoperative teaching regarding a client's expected postoperative course has a positive influence on client's recovery.
preoperative teaching cont. client cites reasons for preoperative instruction and exercises, client states the time of surgery, client states postoperative unit and location of family during surgery and after, client discusses anticipated postoperative monitoring and therapies
preoperative teaching cont. client describe surgical procedures and postoperative treatment, client describes postoperative activity resumption, client verbalizes pain-relief measures, client expresses regarding surgery
acute care activities in the preoperative phase focus on intervention to physically prepare the client for surgery
physical preparation the degree of preoperative physical preparation depends on the client's health status, the planned and the surgeon's preferneces.
maintenance of normal fluid and electrolyte balance client vulnerable to fluid and electrolyte imbalance as a result of inadequate preoperative intake or excessive fluid losses during surgery.
reduction of risk of surgical woud infection risk of developing a surgical wound infection is determined by amount and type of microorganisms contaminating a wound, susceptibility of the host and the surgical wound itself.
prevention of bowel and bladder incontinence some clients receive a bowel preparation if surgery involves gastrointestinal system or lower abdominal organs. manipulation of intestines can cause an abscence of peristalsis for 24 hours.
preparation on day of surgery removal of prostheses, safeguarding valuables, preparing bowel and bladder,vital signs, documentation, performing special procedure, administering preoperative meds, latex sensitivity/allergy, and eliminating wrong site and wrong procedure surgery
evaluation admitting nurse and the nurse in preoperative area evaluate outcomes in preoperative period. interventions continue during and after surgery.
transport to the operating room personnel in the operating room notify nursing division or ambulatory surgery when it is time for surgery. client is identified with two identifiers, be sure of right person.
circulating nurse must be an RN, review of the preoperative assessment, establishing and implementing the intraoperative plan of care, evaluating the care and providing for continuity of care postoperatively.
scrub nurse this nurse maintains a sterile field during the surgical procedure, assists with applying sterile drapes, hand instruments and other sterile supplies to surgeons and counts the sponges and instruments
assessment in intraoperative surgical stage conduct a focused preoperative assessment to verify the client is ready for surgery and to plan intraoperative care.
intraoperative surgical phase care of client during surgery requires careful preparation and knowledge of the events that occur during the surgical procedure.
planning: goals and outcomes client centered outcomes of preoperative care extend into intraoperative phase. Client will have intact skin and show no signs of redness.
implementation acute care physical preparation after safely securing the client on table, apply monitoring devices, apply antiembolism stockings and document
implementation introduction of anesthesia general results in an immobile, quiet client who does not recall surgery. regional results in loss of sensation in certain area. local loss of sensation in certain site. conscious sedation is awake when with depressed LOC
positioning client position client to have good access to operative site
documentation Keep a accurate record of intraoperative procedure and surgical care
postoperative surgical phase after surgery client's care can become complex as a result of physiological changes.
immediate postoperative recovery nursing care focuses in PACU focuses on monitoring maintaining airway, respiratory, circulatory and neurological status and on managing pain
discharge from the postanesthesia care unit evaluate a clients readiness for discharge from the PACU on the basis of vital sign stability in comparison with the preoperative data.
Postanesthesia Recovery Score (PARS) is the most widely used scoring tool.
recovery in ambulatory surgery assess and care for clients in need of close monitoring in the same fashion as inpatient in phase one. after clients stabilize and no longer require close monitoring transfer to phase 2. phase 2 recovery promotes the client's healing
postoperative convalescence inpatient clients remain PACU until their condition stabilizes, they then return to postoperative nursing division. Nursing care focuses on returning the client to a relatively functional level of wellness as soon as possible.
postoperative care assess airway, respiratory, circulatory, fluid and electrolyte, neurological, and skin and incision/would status until the client's discharge from the acute care facility.
assessment airway and respiration, circulation, fluid and electrolyte balance, neurological functions, temperature control, skin integrity, wound condition, gastrointestinal function, genitourinary function, comfort, client expectations.
nursing diagnosis determine status of preoperative nursing diagnosis by clustering new postoperative assessment data, and identify relevant new diagnoses.
goals and outcomes client vital signs return to preoperative baseline. clients airway clients temperature even, fluid and electrolytes and level of activity.
setting priorities PACU,priorities of care include the assessment and stability of client's airway, intervention for an impaired airway, and assessment of the client's respiratory, circulation, and neurological status and pain control.
collaborative care collaborate with other care therapy, dietary, social work and home care to promote healing.
implementation health promotion maintain respiratory function, preventing circulatory complications, achieving rest and comfort.
Acute care implementation temperature regulation, maintaining neurological function, maintaining fluid and electrolyte balance, promoting normal bowel elimination and adequate nutrition, urinary elimination, wound healing,
restorative and continuing care postoperative care the client needs education on how to care for wound, activity level, diet, meds, specifics according to surgery.
Created by: azchic1973