Where can Post-Op take place?
Operating Room and
What is the Art and science of treating diseases, injuries, and deformities by operation and instrumentation?
What are the purposes of surgery?
What are common fears in the patient before surgery?
Altered body image
Why is the psychological assessment of the pt pre-op important?
If stressors or the responses to the stressors are excessive, the stress response can be magnified and recovery can be affected
What four prescription drugs should be aware for when assessing the patient before surgery?
Be alert: tranquilizers, antihypertensives, insulin, blood thinners
What other items should be assessed in regards to medicaton use before surgery?
Over the counter
Recreational drug use
Compliance and Last Dose
The nurse can easily assess patient's medication use by instructing the patient to do what?
Bring meds with to surgery center
If patient is allergic to latex what nursing actions should you consider?
Letting OR team know - prepare a room that is latex free
What are risk factors for latex allergies?
long-term, multiple exposures to latex products, such as those experienced by health care and rubber industry workers. a history of hay fever, asthma, and allergies to certain foods (e.g., avocados, bananas, chestnuts, potatoes, peaches)
What are dz should be noted when reviewing cardiovascular system?
hypertension, angina, dysrhythmias, heart failure, and/or myocardial infarction. note: current treatment for the CV condition (e.g., medications)
T/F: Postoperative venous thromboembolism (VTE), a condition that includes deep vein thrombosis and pulmonary embolism, is a concern for any surgical patient
What are dz should be noted when reviewing resp. system due to their likeliness to compromise resp. status?
recent or chronic respiratory disease or infections, asthma, smokes (encourage to stop 6 weeks before surgery), sleep apnea, obesity, and spinal, chest, and airway deformities, COPD (post op complications such as collapsed lung)
Describe how to assess neuro functioning before surgery?
respond to questions, follow commands, and maintain orderly thought patterns; myasthenia gravis, Parkinson's disease, and multiple sclerosis, and any treatments used
T/F: preoperative assessment of the older person's baseline cognitive function is especially crucial for intraoperative and postoperative evaluation
Describe Obesity on the pt undergoing surgery.
Obesity stresses both the cardiac and pulmonary systems and makes access to the surgical site and anesthesia administration more difficult.14 It predisposes the patient to wound dehiscence, wound infection, and incisional herniation postoperatively. Adipose tissue is less vascular than other types of tissue. In addition, the patient may be slower to recover from anesthesia because the inhalation anesthetic is absorbed and stored by adipose tissue, thus leaving the body more slowly.
Name 15 lab values that should be tested Pre-Op
ABGs, pulse oximetry
Ventilatory and metabolic function; oxygenation status
Metabolic status, diabetes mellitus
Blood urea nitrogen, creatinine
Pulmonary disorders, cardiac enlargement, heart failure
Complete blood count (CBC): RBCs, Hb, Hct, WBCs, WBC differential
Anemia, immune status, infection
Cardiac disease, dysrhythmias, electrolyte abnormalities
Metabolic status, renal function, diuretic side effects
Liver function tests
PT, PTT, INR, platelet count
Pulmonary function studies
Type and crossmatch
Blood availability for replacement (elective surgery patients may have own blood available)
The nurse is providing teaching preoperatively, what is important to remember when completing teaching?
Telling so little = Unprepared
Explaining so much = Overwhelmed
This type of information is what kind of teaching?:
• Preoperative holding area may be noisy.
• Drugs and cleaning solutions may be cold and odorous.
• Operating room (OR) can be cold; warm blankets are available and can be requested.
• Talking may be heard in the OR but may be distorted because of masks. Questions should be asked if something is not understood.
• OR bed will be narrow. A safety strap will be applied over the thighs.
• Lights in the OR may be very bright.
• Monitoring machines may be heard (e.g., ticking and pinging noises) when awake
What type of teaching includes the following info?:
• What to bring and what type of clothing to wear to the surgery center.
• Any changes in time of surgery.
• Fluid and food restrictions.
• Physical preparation required (e.g., bowel or skin preparation).
• Purpose of frequent vital signs assessment.
• Pain control and other comfort measures.
• Why turning, coughing, and deep breathing postoperatively are important; practice sessions need to be done preoperatively.
• Insertion of intravenous lines.
• Procedure for anesthesia administration.
• Expect surgical site and/or side to be marked with indelible ink or marker.
What type of teaching includes Information About General Flow of Surgery such as:
• Admission area.
• Preoperative holding area, OR, and recovery area.
• Caregivers can usually stay in preoperative holding area until surgery.
• Caregivers will be able to see the patient after discharge from the recovery area or possibly in the recovery area once the patient is awake.
• Identification of any technology that may be present on awakening, such as monitors and centr
Informed consent demonstrates what..?
Clear Understanding and Comprehension of their surgery
On the day of surgery what should the patient remove?
Nail polish/artificial nails
Valuables( with caregiver)
What does EBP suggest about NPO status Pre-Op?
Patients not at risk for aspiration can have clear fluids up to 2 hours before surgery.
Less preoperative discomfort
No increase in vomiting
What is acceptable attire in the Unrestricted Area?
Holding area/locker rooms/nurses' station
Street clothes allowed
What is acceptable attire in the Semirestricted Area?
Surgical attire required
Cover head and facial hair
What is a Surgical Timeout?
Identify the patient
Compare hospital ID number with patient's wristband
Prevents wrong site, wrong procedure, and wrong surgery.
Describe the goal of positioning the client during surgery:
Correct alignment, Prevent Pressure, Adequate Thoracic Excursion, Prevent Artery and Vein Occlusion, Position for Individual Needs
What the different types of anesthesia?
Neuromuscular blocking agents: Spinal, Epidural, Regional
Monitored Anesthesia Care
What is General Anesthesia?
• Loss of sensation with loss of consciousness
• Combination of hypnosis, analgesia, and amnesia
• Skeletal muscle relaxation
• Possible impaired ventilatory and cardiovascular function
• Elimination of coughing, gagging, vomiting, and sympathetic nervous system responsiveness
What is Regional Anethesia?
• Loss of sensation to a region of body without loss of consciousness
• Involves blocking a specific nerve or group of nerves with administration of a local anesthetic
• Includes spinal, caudal, and epidural anesthesia and IV and peripheral nerve blocks (e.g., interscalene, axillary, infraclavicular/supraclavicular, popliteal, femoral, sciatic)
DOES NOT BLOCK MOTOR
What is Local Anethesia?
• Loss of sensation without loss of consciousness
• Induced topically or via infiltration, intracutaneously, or subcutaneously
• Topical applications may be aerosolized or nebulized
what is Monitored anesthesia care (MAC) (formerly called conscious sedation)?
• Similar to general anesthesia, sedatives (e.g., benzodiazepines) and opioids are used but at a lower dosage; does not involve inhalation agents
• Relieves anxiety, provides analgesia and amnesia
• Patients remain responsive and breathe without assistance
• May be used in conjunction with regional or local anesthesia
• Often used for minor surgical procedures and diagnostic procedures (e.g., colonoscopy)
Describe the initial assessment in the PACU.
Level of consciousness
Sensory and motor status
Assess surgical site and condition of dressing.
Describe the process of discharge from PACU.
Provide verbal report to receiving nurse.
Receiving unit nurse obtains vital signs and completes assessment and compares with PACU report.
Describe how you should position the patient once they are conscious:
Supine, with HOB elevated (goal: max expansion of airway, and decrease pressure of abdominal contents)
What occurs to anesthesia when you place NC (o2) on a patient:
Increased elimination rate of anesthetic from patient
What should you instruct your pt in PACU to complete in regards to airway clearence?
Breathe deeply and cough ten times an hour
Describe the initial assessment of the patient in the PACU.
• Oral or nasal airway
• Endotracheal tube
• Respiratory rate and quality
• Auscultated breath sounds
• Pulse oximetry
• Supplemental oxygen
• ECG monitoring—rate and rhythm
• Blood pressure
• Capillary refill
• Color of skin
• Peripheral pulses
• Level of consciousness
• Sensory and motor status
• Pupil size and reaction
• Intake (fluids, irrigations)
• Output (urine, drains)
What are three respiratory complications that can result post op?
Hypoventilation, Obstruction, Hyoxemia
Describe how to position your unconscious patient in the PACU.
Unconscious: Lateral "recovery" position
What are three cardiovascular complications that can result post op?
Hypotension, Hypertension, Dysrhythmias
What should the nurse assess the patient for when cardio complications are suspected?
1) Frequent vital signs Look at trends, compare to preop.
2) Change in cardiac rhythm
When hypotension occurs in the post op patient what should be inspected?
Surgical incision inspection
Primary cardiac dysfunction: drug intervention
What are four benefits of early ambulation?
Increases muscle tone
Improves GI and Urinary tract function
Maintains respiratory function
How can the nurse help Maintain normal physiological function?
Bowel and Bladder function
What are common nursing dx in the post op patient?
Decreased cardiac output
Deficient fluid volume
Excess fluid volume
Ineffective peripheral tissue perfusion
What are common problems experienced by the post op patient when arriving on the unit?
Fluid Retention and Overload
Venous Thromboembolism (VTE)
What are four management techniques of managing pain and discomfort?
Analgesics (Slow and titrate, Time around activity)
The following data would altert the nurse to what possible problem: Self-report of discomfort, Restlessness, VS changes
Pain and discomfort
Your patient has Nausea and vomiting. You are assessing their n/v, what should you determine?
Related to anesthesia or surgery?
What causes low urine output post op?
Surgery Stress: Increased aldosterone and ADH
Fluid loss and drainage during surgery
What can cause urine retention in the post op patient? What can treat urine retention?
Anesthesia depresses nervous system, including micturition reflex
Medications: anticholinergic and opioids
What nursing measures can be taken to assist patient in returning to normal urine output?
Drink water/runnning water
Describe the nursing assessment of surgical incisions:
Note amount, color, consistency, and odor
Who should remove the first surgical dressing? drain?
Initial operative dressing: surgeon removes
What education needs to be provided in regards to the surgical wound?
Care of incision and dressings
Medications: actions and side effects
Symptoms to report
Emergency Contact number
What can cause pain in the post op patient?
Trauma from surgery
Reflex muscle spasms
Deep breathing, coughing, ambulating
What type of pain is Numbing, hot-burning, shooting, stabbing, or electrical in nature
Sudden, intense, short-lived, or lingering?
What can be administered to help relieve pain?
IV opiods, Epidural catheters, PCA, or regional anesthetic blockade, NSAIDS
What patient teaching can be completed to help relieve pain?
Non-pharmacologic measures, Appropriate pain medication administration according to patient complaint/assessment, Patient teaching about availability of pain medication
What are the complications of Venous Thrombus?
Life threatening: Thromboembolism to heart, lungs, brain
Obstruction of blood flow from extremity
What are the Nonpharmacologic prevention and prophylaxis of Venous Thrombus?
Activity, nutrition, circulation aids