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level: Level 1 of Lesson 20: Perioperative Nursing

Questions and Answers List

level questions: Level 1 of Lesson 20: Perioperative Nursing

QuestionAnswer
Assessment of Fears: Toddler: Specific fear:Separation
Assessment of Fears: Toddler: Nursing consideration (specific fear):Teach parents to expect regression (in toilet training and difficult separations)
Assessment of Fears: Preschooler: Specific fear:mutilation
Assessment of Fears: Preschooler: Nursing consideration (specific fear):allow child to play with models of equipment
Assessment of Fears: School-age: Specific fear:Loss of control
Assessment of Fears: School-age: Nursing consideration (specific fear):Explain procedures in simple terms
Assessment of Fears: Adolescence: Specific fears:loss of independence, being different from peers, alteration in body image
Assessment of Fears: Adolescence: Nursing consideration (specific fears):Involve in therapies Expect resistance Express understanding of concerns
Obtain Informed Consent: Requirements:Capacity- age (adult), competence (can make choices and can understand consequences) Voluntary- Freedom of choice without force, fraud or deceit Comprehensive- Information must be given in understandable form Influenced- Cannot sign consent if client has been drinking alcohol or has been premedicated
Obtain Informed Consent: Requirements: Age (adult), competence (can make choices and can understand consequences)Capacity
Obtain Informed Consent: Requirements: Freedom of choice without force, fraud or deceitVoluntary
Obtain Informed Consent: Requirements: 3: Information must be given in understandable formInformation must be given in understandable form - (Comprehensive)
Obtain Informed Consent: Requirements: 4:Cannot sign consent if client has been drinking alcohol or has been premedicated
Classification of Surgical Procedures:Urgency- Elective or emergency Risk- minor or major Purpose- diagnostic, ablative, palliative, reconstructive, transplantation, constructive
Classification of Surgical Procedures: 1Urgency- Elective or emergency
Classification of Surgical Procedures: 2:Risk- Minor or major
Classification of Surgical Procedures: 3:Purpose: Diagnostic, ablative, palliative, reconstructive, transplantation, constructive
Purposes of Surgical Procedures: Confirms or establishes a diagnosis; for example, biopsy of a mass in a breast.Diagnostic
Purposes of Surgical Procedures: Relieves or reduces pain or symptoms of a disease; it does not cure; for example, resection of nerve rootsPalliative
Purposes of Surgical Procedures: Removes a diseased body part; for example, removal of a gallbladder (cholecystectomy).Ablative
Purposes of Surgical Procedures: Restores function or appearance that has been lost or reduced; for example, cleft palate repair.Constructive
Purposes of Surgical Procedures: Replaces malfunctioning structures; for example, kidney transplantTransplant
Three Phases of Perioperative Period:Perioperative Intraoperative Postoperative
Three Phases of Perioperative Period: Begins with decision to have surgery, lasts until patient is transferred to operative roomPerioperative
Three Phases of Perioperative Period: Extends from admission to surgical department to transfer to recovery roomIntraoperative
Three Phases of Perioperative Period: Lasts from admission to recovery room to complete recovery from surgeryPostoperative
Types of Anesthesia:General Regional Conscious sedation/ analgesia
Types of Anesthesia: Administration of drugs by inhalation, intravenous, rectal, or oral routeGeneral
Types of Anesthesia: Anesthetic agent injected near a nerve or nerve pathway or around operative siteRegional
Types of Anesthesia: Used for short-term proceduresConscious sedation/ analgesia
Types of Anesthesia: Regional:1. Topical (surface) anesthesia 2. Local anesthesia 3. Nerve block 4. Spinal anesthesia 5. Epidural (peridural) anesthesia
Types of Anesthesia: Regional: Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns.Topical (surface) anesthesia
Types of Anesthesia: Regional: (infiltration is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performing a biopsyLocal anesthesia
Types of Anesthesia: Regional: Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body.A nerve block
Types of Anesthesia: Regional: Is also referred to as a subarachnoid block (SAB). It requires a lumbar puncture through one of the interspaces between lumbar disk 2 (L2) and the sacrum (S1).Spinal anesthesia
Types of Anesthesia: Regional: Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater.Epidural (peridural) anesthesia
Three Phases of General Anesthesia:Induction Maintenance Emergence
Three Phases of General Anesthesia: From administration of anesthesia to ready for incisionInduction
Three Phases of General Anesthesia: From incision to near completion of procedureMaintenance
Three Phases of General Anesthesia: Starts when patient emerges from anesthesia and is ready to leave operating roomEmergence
States of Anesthesia:Loss of consciousness Analgesia Relaxation Loss of reflexes
Preoperative Surgical Phase: Assessment:Risk factors Medications Allergies Smoking habits Alcohol ingestion and substance abuse and use Pregnancy Perceptions and knowledge regarding surgery
Preoperative Surgical Phase: Assessment: Screen patients carefully Take necessary precautions Collaborate with health care provider Obstructive sleep apnea, malnourishment, and smoking are all risk factorsRisk factors
Preoperative Surgical Phase: Assessment: Inpatient v.s. outpatientMedications
Preoperative Surgical Phase: Assessment: Medications, topical agents, latex, foodAllergies
Preoperative Surgical Phase: Planning:Goals and outcomes Setting priorities Teamwork and collaboration
Preoperative Surgical Phase: Planning: Review and modify the plan during the intraoperative and postoperative periodsGoals and outcomes
Preoperative Surgical Phase: Planning: Patients requiring emergent surgery often experience changes in their physiological status that require urgent reprioriticaions.Setting priorities
Preoperative Surgical Phase: Planning: Preoperative instruction gives patients time to make necessary preparationsTeamwork and Collaboration
Preoperative Surgical Phase: Implementation:Informed consent Privacy and social media Health promotion
Preoperative Surgical Phase: Implementation: Preoperative teaching Postoperative activity resumption Pain relief measures Rest Feelings regarding surgeryHealth Promotion
Preoperative Surgical Phase: Implementation: health promotion: Reasons for preoperative instructions and exercises preoperative routines Surgical procedure Time of surgery Postoperative unit and location of family during surgery and recovery Anticipated postoperative monitoring and therapies Sensory preparationPreoperative teaching
Preoperative Surgical Phase: Implementation: Surgical procedures require documentation of consent Report any concerns about the patient's understanding of the surgery to the operating surgeon or anesthesia providerInformed consent
Preoperative Surgical Phase: Implementation: Do not discuss confidential patient information in public areas or use social media to convey patient information; posting patient information and photos on websites is prohibitedprivacy and social media
Nurse's Role ins Presurgical Testing:Ensure tests are explained to the patient Ensure results are recorded in patient records before surgery. Ensure that abnormal results are reported.
Preoperative Surgical Phase: Implementation: Acute care: Hygiene Preparation of hair and removal of cosmetics Removal of prostheses Safeguarding valuables Preparing the bowel and bladder Vital signs Prevention of DVT - Antiembolism devices Administering preoperative medications Documentation and hand-off Eliminating wrong site and wrong procedure surgeryAcute care
Preoperative Surgical Phase: Evaluation:Through the patient's eyes Patient outcomes
Preoperative Surgical Phase: Evaluation: Evaluate whether the patient's expectations were met with respect to surgical preparationThrough the patient's eyes
Preoperative Surgical Phase: Evaluation: Deficient knowledge AnxietyPatient outcomes
Preparing the Patient through teaching:Surgical events and sensations Pain management Physical activities Deep breathing Coughing Incentive spirometry Leg exercises Turning in bed
Transporting to the Operating Room:Notification Transportation Verify patient's identity- two identifiers Family- allowed to visit before patient is transported to OR - Directed to waiting area Prepare room for patient's return
Preanesthesia care unit (PCU):or presurgical care unit (PSCU) (holding area) PCU nurse Anesthesia provider
Preanesthesia care unit (PCU): Inserts IV catheter (if not already present) Administers preoperative medications Monitors vital signsPCU nurse
Preanesthesia care unit (PCU): Performs patient assessmentAnesthesia provider
Intraoperative Surgical Phase: Nursing roles during surgery:Circulating nurse Scrub nurse Registered nurse first assistant
Intraoperative Surgical Phase: Implementation: Physical preparation Intraoperative warming Latex sensitivity/allergyAcute care
Intraoperative Surgical Phase: Implementation:Introduction of anesthesia Positioning the patient for surgery Documentation of intraoperative care
Intraoperative Surgical Phase: Implementation: General anesthesia Regional anesthesia Moderate (conscious) sedationIntroduction of anesthesia
Substances that can affect the client in surgery:Antibiotics Antibiotics in mycin group Anticholinergics Anticoagulants Anticonvulsants Antidysrhythmics Antidepressants Antihypertensives Corticosteroids Diuretics Herbal substances Insulin
Substances that can affect the client in surgery: Potentiate action of anesthetic agentsAntibiotics
Substances that can affect the client in surgery: Respiratory paralysis when combined with certain muscle relaxantsantibiotics in mycin group
Substances that can affect the client in surgery: Increases the potential for confusionAnticholinergics
Substances that can affect the client in surgery: Alter normal clotting factor and increase risk of hemorrhage; should be discontinued 48 hrs before surgery or as specified by the surgeon Precipitate hemorrhageAnticoagulants
Substances that can affect the client in surgery: Alter the metabolism of anesthetic agentsAnticonvulsants
Substances that can affect the client in surgery: Reduce cardiac contractility and impair cardiac conduction during anesthesiaAntidysrhythmics
Substances that can affect the client in surgery: Lower BP during anesthesia Tranquilizers- increase hypotensive effects of anesthetic agentsAntidepressants
Substances that can affect the client in surgery: Cause bradycardia, hypotension and impaired circulationAntihypertensives
Substances that can affect the client in surgery: Cause adrenal atrophy and reduce the body's ability to withstand stress Adrenal steroids- abrupt withdrawal may cause cardiovascular collapseCorticosteroids
Substances that can affect the client in surgery: Potentiate electrolyte imbalance - electrolyte imbalances, respiratory depression from anesthesiaDiuretics
Substances that can affect the client in surgery: Interact with anesthesia and can cause variety of adverse effects. May need to be stopped before surgeryHerbal substances
Substances that can affect the client in surgery: Need for it may be decreased because the client's nutritional status is reduced; or the insulin may be increases because of stress response and IV administration of glucose solutions after surgery.Insulin
Postoperative assessments and interventionsVital signs Color and temperature of skin Level of consciousness Intravenous fluids Surgical site Other tubes Comfort Position and safety
1 to 4 hours after surgery Full system assessment (anesthesia can affect any system)Postoperative Care
Postoperative care: Stimulate patient postanesthesia Monitor level of consciousnessNeuropsychosocial
Postoperative care: Monitor vital signs q 15 minutes 4 times, q 30 two times, q hour one time, then as neededcardiovascular
Postoperative care: Check breath sounds Splint wound Offer pain medication Teach incentive spirometer Get out of bed as soon as possible Turn, cough, and deep breath (unless contraindicated; brain, spinal, eye surgery) if cannot move out of bedRespiratory
Postoperative care: Check bowel sounds in 4 quadrants (5 min each Keep NPO until bowel sounds are present provide good oral care while NPO Check abdomen for distention Check for passage of flatus and stoolGastrointestinal
Postoperative care: Monitor I & O (intake and output) Encourage to void Notify MD if unable to void within 8 h Catheterize is neededGenitourinary
Postoperative care: Check pulses Inform patient not to cross legs Prohibit pillow behind knee Monitor for Homan's sign- dorsiflexion of footExtremities
Return of consciousnessUnconscious Response to touch and sounds Drowsiness Awake but not oriented Awake and oriented
Potential Complications of Surgery: Hemmorhage: Assessment: Nursing considerations:Assessment: decreased BP, increased pulse, cold clammy skin Nursing considerations: monitor vital signs
Potential Complications of Surgery: Paralytic ileus: Assessment: Nursing considerations:Assessment: absent bowel sound, no flatus or stool Nursing considerations: gastric lavage, IV fluids
Potential Complications of Surgery: Atelectasis: Assessment: Nursing considerations:Assessment: Pain on the affected side, dyspnea, cough, fever, tachycardia Nursing considerations: Experienced 2nd day post op suctioning postural drainage cough and turn
Potential Complications of Surgery: Dehiscence: Assessment: Nursing considerations:Assessment: separation of wound edges Nursing considerations: Experienced 5-6 days post op Low-fowler's position No coughing Notify physician
Potential Complications of Surgery: Eviscration: Assessment: Nursing considerations:Assessment: bowel erupts through surgical site Nursing considerations: Experienced 5-6 d postop Low fowler's position No coughing NPO Cover viscera with sterile saline dressing or wax paper (if at home) Notify physician
Cardiovascular Complications:Hemorrhage Shock Thrombophlebitis Pulmonary embolus
Interventions to Prevent Respiratory ComplicationsMonitor vital signs Implementing deep breathing Coughing Incentive spirometry Turning in bed Ambulating Maintaining hydration Avoiding positioning that decreases ventilation Monitoring responses to narcotic analgesics
Surgical drains:Penrose tube Jackson-Pratt
Surgical drains: Simple latex drain Nursing considerations: Note location Usually not sutured in place, but layered in gauze dressingPenrose
Surgical drains: Used after gallbladder surgery Placed in common bile duct to allow passage of bile Nursing considerations: Fasten tubing to dressings Keep below waist May clamp for 1 hour before and after each meal May be discharged with T tube in place Remove 7-14 daysTube
Surgical drains: Portable wound self-suction device with reservoir Nursing considerations: Monitor amount and character of drainage Notify physician if it suddenly increases or becomes bright redJackson-Pratt
Safety Guidelines for Nursing Skills:Coughing and deep breathing may be contraindicated after brain, spinal, head, neck, or eye surgery Bariatric patients may have more improved lung function and vital capacity in the reverse Trendelenburg or side-lying position. Report any signs of venous thromboembolism such as pain, tenderness, redness, warmth, or swelling in the upper or lower extremities to the medical team immediately.