Glossary of Nurs 104 lecture week 1 Perioperative Nursing
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- Term used to describe interventions associated c clients experience
- perioperative nsg.
- 3 stages of perioperative nsg
- pre, intra, post
- when does the preoperative phases start?
- c decision of surgical intervention
- when does preoperative phase end?
- when client is transferred to OR bed
- who makes the decision about surgical intervention?
- its collaborative
- when does the intraoperative phase start?
- when admitted to OR
- when does the intraoperative phase end?
- when transferred to recovery rm
- when does postoperative phase begin?
- when admitted to recovery rm
- when does post op phase end?
- with follow up visit
- What 5 classifications of surgery are there?
- Why is diagnostic surgery done?
- to verify a suspected dx
- ex of a diagnostic surgery
- what's the reason for a curative surgery?
- to remove or repair diseased or damaged tissue or organs.
- ex of curative surgery
- appendix, cholecystectomy
- what's the reason for a palliative surgery?
- to relieve symptoms
- ex of a palliative surgery?
- cut nerves in certain places, gastrostomy tube
- what's the purpose of cosmetic surgery?
- to repair by improving func or appearance
- ex of cosmetic surgery:
- what's the purpose of restorative surgery:
- to improve functional ability
- ex of restorative surgery:
- joint surgery, jaw replacement, laser eye surgery
- Classifications of surgery according to degree of urgency:
urgent or imperative
planned or required
- why is emergency surgery performed?
- immediate/life threatening
- ex. of emergency surgery:
- appendicitis, aneurysm, gunshot wound
- urgent or imperative surgery is done for things:
- that req. prompt attn (24-48hrs)
- Whats an ex. of imperative/urgent surgery?
- kidney stones
- Requires surgery within a few days or weeks
- planned or req. surgery
- ex of a planned or req. surgery:
- tonsillectomy, thyroid, hernia
- ex of elective surgery
- simple hernia, knee surgery
- during the pre op phase, the nurse does what?
- health hx
-tell them what to expect after surgery
- during the intra op phase, the nurse does what?
- position pt properly, time in and out, right site, surgery, prepare with tools.
- during the post op hase the nurse does what?
- education, dressing changes, physical restricition, special diet, c&DP, fluids, bowels functioning, psychosocial
- What is it called when you should have surgery but failure to not is not catastrophic
- decision to have surgery is determined by clients personal preference
- ex of optional sugery
- 3 risk factors for the surgical client
- what influences one's response to the stress of surgery
- pulmonary disease and smoking affect:
- post op resp status.
- client has increased secretions and decreased ability to expel anesthesia with
- pulmonary disease and smoking
- the purpose of the preoperative assessment is
- to ensure safety
- provides baseline for providing perioperative care
- preoperative assessment
- the preop assessment assists with identifying
- risk factors
- after 30 y.o., organs decline ______ every year
- 1 %
- the elderly's (>65) response to stress is
- the elderly have a gradual decline in
- physiological reserve
- _________ has a loss in artery and vessel elasticity
- the elderly
- aging is at what level?
- @ risk for aspirations starts @ age
- alcoholism and ilicit drugs can
- cause serious s/a with anesthesia and surgery
- people with immunosuppressive diseases are
- @ increased risk for infection (e.g. CA & HIV)
- people with renal/hepatic disease have
- decreased metabolism and execretion of anesthetics and meds
- ppl with renal/hepatic disease have ________ problems
- __________may experience post op bleeding and poor wound healing
- ppl with renal/hepatic problems.
- infants are at risk during surgery because their ________ is undeveloped
- temp control
- the physiological assessment assesses:
- integumentary status
- client with DM req. _______ levels to be drawn morning of surgery
- serum glucose
- electrolytes have to be taken within 30 days of surgery if the client is on: (3)
hx cardiac/renal dx
- OR room is cold to decrease
- bacteria growth
- NPO status should be ___-___ hours prior to surgery to prevent aspiration)
- parenteral fluids are started before surgery to prevent
- dehydration and electrolyte imbalance
- developed as alternative to bld transfusions
- bloodless surgery program
- keep parent in
- infant's line of vision
- if parent is unable to be with infant,
- place familiar object with infant
- when preparing children for procedure, limit
- number of strangers entering room during procedure
- During procedure with child, use sensory soothing measures such as: (3)
- stroke skin
- encourage parent to______ after procedure
- comfort child\
- what should you do if child has temper tantrum
- ignore it
- use ________ words to describe procedure
- malnourished ppl are @ risk for complications because
- wounds wont heal
- the obese pt having surgery is at risk because
- diff breathing, moving, ambulating, > risk for airway obstruction, increase soft tissue in upper airway
- ppl with cardiovascular disease are @ risk and prone to complications because
- theres a decrease in the blood to organs
- Males >50 and postmenopausal women must have ___ within 1 yr of surgery
- ppl with hx of heart disease must have ___ within 3 mo of surgery
- all clients must have what blood test done prior to surgery?
- when assessing someones circulatory status, assess:
- hr, rhythm, sounds, color
- ppl with hx of resp dx must have_____ prior to surgery
- during the psychosocial assessment, assess the following: (8)
- psychological readiness
knowledge of surgery
preop fear and anxiety
- ________ is common after surgery
- ppl with hx of liver disease need to have a
- liver function test
- ppl with kidney problems need to have a ________ within _______ days of surgery. If abnormal, ___ &____ are obtained
- urine analysis
- 30 mL lost in adult is equivalent to ___mL lost in adult
- when is the area marked by the surgeon? When?
- Holding area
just prior to surgery
- the limb or area marked by surgeon usually in holding area just prior to surgery is called:
- correct site surgery
- what if someone is in for surgery but they have a resp infection?
- surgery is postponed
- If client has resp infection during surgery it can cause _________ and ___________ which could lead to resp failure
- If while doing your physiological assessment, you find your client has musculoskeletal problems, you should check ______, because__________
might cause coagulation problems
- what is it called when consent is freely given without coercion?
- consent voluntarily given
- how many ppl need to witness a phone consent for surgery?
- when must the consent to medical services and anesthetic need to be completed
- no more then 30 days prior to surgery.
- when should the client bathe prior to surgery?
- evening before
- instruct pre op client to stop smoking how long before surgery?
- 4-6 wks
- client should use incentive spirometer___x per hour or Cough and deep breathe __-___x per hour
- what position should the pre op client lay in while deep breathing?
- semi fowlers
- preop meds are generally given ___ before surgery "on call" to OR
- 4 types of medications administered preoperatively
- what 3 types of tranquilizers could be given preoperatively
- midazolam (versed)
- what are 3 types of narcotic analgesics administered preoperatively?
- meperidine (demerol)
- What are 3 types of anticholenergics administered preoperatively?
- glycopyrrolate (robinul)
- do you need an order to get a client oob after surgery?
- clients with abd surgery or knee/hip surgery need to get oob when?
- 1 day after surgery
- 3 ways to promote circulation and prevent venous stasis (DVT) in the preop client
- leg exercises
pneumatic compression device as ordered
- instruct client to ___ just prior to surgery
- when does shaving the operative site occur?
- just prior to surgery
- some biological agents such as erythropoetin, a hormone produced by the kidney, stimulates
- rbc production
- children younger then 5 fear:
- what will happen when they wake
- schoolage children fear:
- anesthesia itself
- children older then 9 fear:
- anesthesia, surgery, death
- since schoolage children fear anesthesia, let them:
- place with the mask
- can parents go into the OR with their child?
- where should you perform painful procedures on a child?
- in a seperate room, not in a crib or bed.
- use distraction techniques when preparing a child for a procedure such as:
- sing a song WITH the child
- allow child to wear ____ under gown
- what are 3 potential neuropsychologic problems with the post op patient?
- 3 potential urinary problems with the post op pt.
- 4 potential integumentary problems with the post op pt.
dehiscence and evisceration
- 6 potential respiratory problems with the post op pt.
- airway obstruction
aspiration of vomitus
- 5 potential cardiovascular problems with the post op pt.
hypotension and shock
thrombosis and phlebitis
- 4 potential fluid and electrolyte problems with the post op pt.
- fluid overload
- 5 potential GI problems with the post op pt.
distention and flatulence
delayed gastric emptying
- when admitted into PACU (post anesthesia care unit) from the OR, what is the priority assessment?
- two common causes of inadequate airway exchange is:
- airway obstruction
- airway obstruction is caused by muscle relaxants or narcotics and causes:
- the tongue to fall to the back of the mouth
- Mucous accumulation is seen:
- esp in smokers or pts w/previous resp conditions.
- mild ___________ is common for the first 48 hrs after surgery
- the client must meet the following criteria to be discharged from the pacu to go to the med-surg floor or discharged to home.
- 1. uncompromised pulmonary fx
2. stable v/s
3. orientation to person, place and time.
4. adequate urine output
5. n/v and pain under control
- who discharges client from pacu?
- incomplete expansion of the lung or at least a portion of the lung
- all post op clients have some degress of _________ but it usually resolves.
- what adventitious sounds do you hear with atelectasis?
- crackles or decreased breath sounds
- Where do you hear adventitious sounds with atelectasis?
- bases of lungs
- what sound do you hear upon percussion on the pt with atelectasis
- atelectasis is caused by
- airway onstruction
- what 2 things can cause airway obstruction resulting in atelectasis?
- mucous plug in bronchiole tree
viscous bronchial secretions
- inflammation on the lungs which can occur following surgery
- 3 causes of pneumonia following surgery:
- retained secretions
lack of periodic Deep breaths
- inhalation of gastric contents into the tracheobronchial system
- if pt has secretions while being assessed in the pacu:
- turn client to one side and suction
- maintain ___________ and __________ airway until gag reflex returns
- in the pacu, pt should maintain _______ position unless contraindicated or bld pressure falls
- semi fowlers
- a considerable loss of fluid from surgery:
- if a particular area is painful, it could mean:
- if someone is bleeding in their abd, they may have pain where?
- in their back
- if someone is cleeding in the groin from femoral artery, they will feel:
- numbness or coolness in toes
- excessive blood loss may lead to:
- client may complain of ___________ preceeding shock
- impending doom
- pulls from intracellular and intersitial spaces into bld vessels:
- hypertonic fluids
- replaces fluid loss from tissues by moving water out of bld vessels into the intracellular and interstitial spaces
- hypotonic fluids
- match serum osmolarity and are used to increase intravascular vol and boost perfusion to vital orgrans
- isotonic fluids
- aka plasma volume expanders
- a normal component of blood. Pulls fluid from extravascular space to vascular space
- same volume expanding characteristics as albumin but is artificial
- a glucose polymer that stimulates the properties of albumin also increases vol in the vascular space (same thing albumin does)
- drying out of a wound
- overhydration of a wound or cells
- what is maceration caused by?
- how is maceration controlled?
- by performing freq. dressing changes
- why is maceration not good?
- it can delay wound healing
- what is the proper position of the pt who shows signs of shock?
- elevate lower extremities by 20 degrees.
head slightly elevated
- inflammation of a deep vein in conjunction with blood clotting.
- The high risk period for a pulmonary embolism is:
- 2-14 days post op
- a clot or embolus traveling in the blood stream which was dislodged from an original site. Clot travels into pulmonary artery or one of its branches and blocks it off
- pulmonary embolism
- if nothing is done to treat a pulmonary embolism, death can:
- occur within 30 min
- a common post op complaint is:
- the complaint of n/v postoperatively is more common in :
- women and children more then men
- nausea from anesthesia should last no more then _______ after surgery
- 12-24 h
- if n/v occur more than 4 days then its prob from
- post op narcotics
- txt for constipation in the post op client
- get oob to walk asap
encourage fluids as appropriate
cathartics or enema to stimulate peristalsis
- urinary retention should resolve in the post op client:
- within 48 h
- if the post op's urinary output is not ___cc/hr, REPORT!
- if a post op client with a catheter has the catheter removed, they should void:
- within 6-8 h
- D T V stands for
- due to void
- leakage of cerebral spinal fluid at the dual puncture site which decreases the csf pressure that normall cushions the brain causing:
- spinal headache
- what type of h/a is often seen after general anesthesia?
- why do post op pt.'s usually have a sinus h/a?
- gas is trapped in the sinuses causing pressure
- hoarseness is normal for first 24h after extubation. beyond 24h could indicate:
- laryngeal nerve injury, vocal cord problems.
- if post op pt has hoarseness beyond 24 hrs, they should:
- notify anesthesiologist
- wound that is closed at time it is made:
- primary intention closure
- wounds heal by secondary intention when there is bacterial contamination &/or extensive tissue loss
- secondary intention closure
- wound edges should be water tight in 48 h
- primary intention closure
- One advantage to this type of wound closure is that it allows wound to heal w/o trapping in infection
- delayed/tertiary closure
- type of wound closure that hase well approximated edges and minimal scarring
- primary intention wound closure
- What are 3 examples in which we would use a delayed or tertiary wound closure:
- gun shot wound
motor vehicle accident
- what is one example in which we would use primary intention closure:
- surgical incision
- the wound is closed with sutures, staples, or could be closed below the epidermis with absorbable sutures
- primary intention closure
- what type of wound closure would be used with an animal bite or a pressure ulcer?
- secondary intention closure
- Wounds that are left open following surgery, because of bacterial contamination are closed with:
- delayed or tertiary closure
- wound is closed at fascia and muscle level. The subcutaneous layer and skin is left open
- secondary intention closure
- wound is kept moist with dressing. It's cleaned and debrided, usually by repeated packing.
- delayed or tertiary closure
- the inflammatory or reaction phase of wound healing lasts about ____
- 3-4 days
- the proliferative or regenerative phase of wound healing lasts:
- 4-21 days
- the maturation or remodeling phase of wound healing lasts
- 3wks to 3yrs
- characterized by the extreme alteration in arousal, orientation, perception, affect and attn. (pt is freq. combative)
- emergence delirium
- what does sanguineous drainage mean?
- what does serosanguanous drainage look like?
- thin, red/yellowish
- what does purulent drainage look like?
- what does serous drainage look like?
- its normal for wound edges to be inflamed and swollen for _____
- a planned alteration of the human body designed to arrest, alleviate or eradicate some pathological process
- perioperative nursing practice can be preformed in a variety of setttings: (4)
freestanding ambulatory centers
- There are a variety of roles a registered nurse can have during the intra op period: (6)
- -scrub person
-rn first assistant (RNFA)
- four intraoperative nursing diagnoses:
- risk for infection
risk for imbalanced fluid vol
risk for imbalanced body temp
risk for injury
- Before surgery is started there is a time out. During this time out, they check:
- -right pt
- 15-30% TBV loss is a ____ problme
- 30-45% of TBV lost is a ________ problem
- 15% of TBV loss is a _____ problem
- >45% TBV loss is a _______ problem
- When monitoring for blood loss, do a visual inspection of:
- suction containers
- what was the first lecture to nurse?
- surgical instrument preparation for surgery
- what year did perioperative nursing start?
- what are the four areas we pay attn to during surgery? (the four areas of primary concern)
- what is the best technique to limit blood loss?
- direct pressure
- why is direct pressue the best technique to limit blood loss?
- because there are no foreign material
- Ice can help:
- decrease bleeding
- What are four types of volume replacement?
- homologous blood
intraop blood salvage
- In the reverse trendelenburg, which is higher the feet or the head?
- in the trendelenburg position, which is higher, the feet or the head?
- partial or complete loss of sensation, with or without the loss of consciousness
- A reversibe, unconscious state characterized by amnesia, analgesia, depression of relexes, muscle relaxation and homeostasis
- general anesthesia
- types of anesthesia:(5)
monitored anesthesia care (MAC)
- 2 types of IV barbiturates used for induction:
- 4 types of IV drugs used for induction:
neuromuscular blocking agents
- 2 types of IV Non barbiturates used for induction:
- what 2 types of IV drugs used for induction have rapid induction?
- what 3 types of iv drugs used for induction are short acting?
- what is a rapidly metabolized iv drug used for induction?
- used to relax the jaw and vocal cords providing continued muscle relaxation during surgery.
- neuromuscular blocking agents
- decision for type of anesthesia?
- -type, duration, local of surg procedure
-preanesthetic physicla condition
- what do all opiods do?
- depress respiration
- 4 examples of opiods:
- 3 stages of anesthesia:
- how many stages does induction have?
- what are the for stages of induction?:
- three types of general anesthesia:
- what are 4 potential hazards related to electrosurgical safety?
- faulty unit
skin to metal
skin to moisture
grounding pad placement
- the administration of an anesthetic agent to one part of the body by local infiltration or topical application of anesthetic
- local anesthesia
- 3 types of regional anesthesia?
- spinal block
regional field blocks
- reversible loss of sensation, without the loss of consciousness, in a specific area or region of the body whenlocal anesthetic is injected to block or anesthetize nervefiber in and around the operative site
- regional anesthesia
- emergence from anesthesia is the reversal:
- of neuromuscular blocking agent
- pressre on the cricoid cartilage during inductino of anesthesia does what?
- compresses esophagus preventing passive regurgitation of stomach contents into the airway
- a state that allows pt to tolerate unpleasant procedures while maintaining adequate cardiopulmonary fx and the ability to respond purposefully to verbal and tactile command
- conscious sedation
- who should a pt stop smoking 4-6 wks prrior to surgery?
- has to do with hgb carrying capacity and general health of resp tract
- maintain vol by diluting blood.....but complications may occur.
- What can you dilute the blood with, with hemodilution?
- ringers lactate
- WHO MAY perform the intraop blood salvage?
- pts need to be warmed up to recover from
- pharmacological hemostatic agents can be ____ or ____. they are used to ____blood loss. 2 examples are:
- topical/inj/decrease/lidocaine, epinephrine
- how many inches above the elbow is sterile?
- 4 methods of sterilzation/disinfection?
- how often can blood be donated?
- every 4th day
- blood can be donoted no lesss then __ hrs pre op.
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