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exam 1 med surge key points
peri-operative ch. 16-18
Terms in this set (75)
when does the intraoperative period begin?
when the patient enters the surgical suite and ends at the time of transfer to the PACU/ICU.
what are the main concerns of perioperative nurses?
safety and advocacy during surgery
in the operating room what is the the patient at risk for?
risk for infection, impaired skin integrity, increased anxiety, altered body temp., injury related to postioning and other hazards.
what does the surgical team consist of?
surgeon, one or more surgical assistants, the anesthesia provider, and OR nursing staff
physician who specializes in giving anesthetic agents
a registered nurse with additional education and credentials who delivers anesthetic agents under supervision
certified nurse anesthetist (CRNA)
nurse that uses clinical decison-making skills, develops a plan of care, and cooridinates care delivery to patients and their family members during surgery
nurse that works in presurgical holding areas coordinating care, reviewing the medical record and preop checklist, verifying that the operative consent forms are signed, and documenting the risk assessment
holding area nurse
registered nurse who coordinates patients care in the OR, setting up the OR, and ensuring that supplies are available as needed. (may assume the responsibilities of the holding area role)
circulating nurse "circulators"
this nurse also assists the OR team in the pt. transfer to the bed, positioning the patient and protecting bony areas, providing comfort and reassurance, inserting a foley catheter if needed, and scrubbing the surgical site
circulator (circulating nurse)
which nurse sets up the sterile field, drape the pt. and hand sterile supplies, and instruments to the surgeon and the assistant.
what should the circulating nurse review before the surgery?
medial record, pre-op checklist, informed consent forms, allergies, and previous reactions to blood or anesthesia, complete skin prep, ask pt. when the last he/she had anything to eat or drink, asses for tachycardia, increased carbon dioxide level and increased body temp. (indicator for malignant hyperthermia),
if there are any discrepancies btwn what type of surgery that pt. says is going to be performed and what the informed consent form indicates who should you contact?
an induced state of partial or total loss of sensation, w. or w.o loss of consciousness, to block nerve impulse trasmission, suppress reflexes, promote muscle relaxation, and in some cases achieve unconsciousness.
a reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS, resulting in analgesia and amnesia
complications of general anesthesia can range from?
minor and annoying, such as sore throat, to death.
an acute, life threatening complication of certain drugs used for general anesthesia?
malignant hyperthermia (MH)
what can occur if the pts. metabolism and drug elimination are slower than expected?
what are some complications of intubation?
broken or injured teeth and caps, swollen lip, or vocal cord trauma
anesthesia that is delivered topically and by local infiltration, meaning injected directly into the tissue around an incision, wound, or lesion,
a type of local anesthesia that blocks multiple peripheral nerves in a specific body region
the IV delivery of drugs to reduce the LOC but allow the patient to maintain a patent airway and and respond to verbal commands.
reinfusing the pts. own blood, may be used for surgery
autologous blood transfusion
during surgery who maintains an accurate count of sponges, sharps, instruments, and amount of irrigation fluid and drugs used?
the scrub person and circulating nurse.
which nurse monitors traffic, assess the amounts of urine and blood loss, reports findings to the surgeon and anesthesia provider, and ensures that the surgical team maintains sterile technique and sterile field?
who anticipates the patients and surgical teams needs, communicates information about the pts. status to family members, and documents care, events interventions and findings?
before the surgery/procedure is over what does the circulating nurse do?
completes documentation, notes the length of the surgery, counts all sponged, sharps, instruments, and notifies the PACU of the pts eta and any special needs
the patient is never left?
why is minimally invasive surgery (MIS) a preferred technique for many surgeries?
reduces surgery time, allows smaller incisions, reduces blood loss, and promotes faster recovery time and less pain
what should you monitor for immediately after moderate sedation?
airway, LOC, O2 sat, ECG, and VS
patients are at risk in the OR for?
surgical injuries, disuse syndrome, hypothermia, fear, anxiety, fluid volume deficit, and peripheral neurovascular dysfunction
what are 2 categories of injury that a ptient can incur during MIS and robotic surgery?
mechanical trauma and thermal injury
what are a couple of expected outcomes for a patient from surgery?
safely anesthetized w/o complications
pt. doesnt experience any injury related to surgical positioning or equipment
patient is free of skin or tissue contamination during surgery and is free of ksin tears, bruisesredness, abrasion, or maceration over pressure points and elswhere.
When does the post-op period start?
at the completion of surgery and transfer to PACU/ICU
What is the purpose of the PACU?
for ongoing evaluation and stabilization of pt pts, to anticipate, prevent and treat complications after surgery
after surgery is complete who accompanies the pt. to the PACU?
circulating nurse and anesthesia provider
on arrival, the anesthesia provider and circulating nurse give the PACU or ICU nurse what?
a verbal "hand-off" report to communicate the pts condition and needs
after receiving the surgical teams verbal report and assesing the pt. the PACU nurse reviews what>
the medical record for pts history, presurgical physical condition and emotional status
assessment data in the PACU includes?
LOC, temp., pulse, respirations, o2 sat, BP, and eval of surgical area bleeding
how often are VS and heart sounds assessed in the PACU?
on admission and at least every 15 minutes.
what is the most important assessment?
what the patient is admitted to the PACU immediately asses??
a patent airway and adequate gas exchange
what are among the most common reactions after surgey?
nausea and vomiting
this causes shivering that increases oxygen demand and can induce hypoxemia
the highest incidence of hypothermia after surgery occurs when?
2nd post op day
about how long does it take a clean surgical wound to heal at skin level?
about 2 weeks
(in the absence of trauma, connective tissue disease, malnutrition, infection, or the use of drugs such as sterioids)
who is at an increased risk for delayed wound healing?
smokers, olders, obese, diabetic, those w. reduced immunity
about how long does complete healing of all tissue layers within the wound after surgery take?
6 months-2 yrs
who usually performs the first dressing change? and why?
to assess the wound, remove any packing, and advance or remove drains
what kind of technique is used during all dressing changes?
what are priority nursing diagnoses after surgery?
impaired gas exchange
impaired skin integrity
potential for hypoxemia
if dehiscence or evisceration occurs what should you do?
apply a sterile nonadherent or saline dressing to the wound, have patient lie flat w knees bent to reduce intra-abdominal pressure, notify surgeon.
what are some criteria for discharge after surgery?
stable vital signs, normal body temps, no overt bleeding, return of gag reflex, cough, and swallow reflexes, and the ability to take liquids
once the pt. is discharged from the PACU vital signs are often measured when?
every 15 min. for 4x.
every 30 mins for 4x,
every 2 hours for 4x, and then
every 4 hrs for 24-48 hrs
during the post-op period all patients remain at risk for what?
pneumonia, shock, cardiac arrest, respiratory arrst, DVT, and bleeding
what does the teaching plan for pts and familiy include after surgery?
prevention of infection, care and assessment of the surgical wound, management of drains or catheters, diet therapy, pain managemnt, drug therapy, and progressive increase in activity schedule
what are some interventions to teach the pt to reinforce to prevent complications after surgery?
incision splinting, deep breathing exercises and ROM exercises.
what are some alternative therapies for relaxation and pain reduction?
massage, music therapy, and guided imagery,
how are surgical procedures categorized?
purpose, body location, extent and degree or urgency
term that refers to a pt. who goes to the surgical area the day of the surgery and returns home on the same day?
perioperative nurses function as?
an educator, an advocate, promoter of health
when does the pre-op period begin?
when the pt. is scheduled for surgery and ends at the time of transfer to the surgical suite
what does the pre-op period focus on?
preparing pt. for surgery
interventions required to reduce anxiety and complications and to promote pt. cooperation for post op procedures
what is not used to identify a pt?
room number and bed number
pulmonary complications from surgery are more likely to occur in who?
olders, chronic resp. problems and smokers
pre-op; any abnormal assessment findings are reported to who?
surgeon and anesthesia provider
pre-op: communicate any concerns or fears the patient has to who?
surgeon and anesthesia personnel
autologous blood donation for surgey can be made when?
up to 5 weeks before the scheduled surgery date
when should discharge planning be started?
documentation of patient education should include what?
who was involved in teaching
what was taught
and the educational materials given to pt.
pre-op: what should you ask the pt. about his/her surgery?
to explain in his/her own words what surgical procedure is being done and why
if the pts explanation of the surgery is not consistent w/ the documentation, notify?
the surgeon and request that he/she speak to pt.
why may pre-op drugs be prescribed?
to reduce anxiety
reduce nasal and oral secretions
reduce vagal-induced bradycardia
inhibit gastric secretions
decrease amount of anesthetic needed for the induction and maintenance of anethesia
why might a urinary catheter be inserted?
prevent injury to bladder, and to measure accurate output
why is mobility soon after surgery good?
stimulate intestinal motility
enhances lung expansion
promotes venous return
prevents joint rigidity
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