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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
-preop instructions
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
chronic disease
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?
alcoholism and ilicit drugs can
cause serious s/a with anesthesia and surgery
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
resp status
circulatory status
nutritional status
elimination 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
talk softly
give pacifier
encourage parent to______ after procedure
comfort child\
what should you do if child has temper tantrum
ignore it
use ________ words to describe procedure
the obese pt having surgery is at risk because
diff breathing, moving, ambulating, > risk for airway obstruction, increase soft tissue in upper airway
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
support system
med allergies
substance abuse
________ 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)
diazapam (valium)
lorazepam (lorazepam)
what are 3 types of narcotic analgesics administered preoperatively?
meperidine (demerol)
Fentanyl (sublimaze)
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
antiembolic stockings
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.
renal failure
4 potential integumentary problems with the post op pt.
dehiscence and evisceration
keloid formation
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
pulmonary embolism
postural hypotension
4 potential fluid and electrolyte problems with the post op pt.
fluid overload
fluid deficit
acid-base disorders
5 potential GI problems with the post op pt.
distention and flatulence
paralytic ileus
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?
excessive drainage
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.
knees straight
trunk horizontal
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
ruptured appendix.
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
physician offices
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
-right procedure
-right site/side
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
drain devices
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)
heat loss
fluid vol
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
autologous 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)
conscious sedation
monitored anesthesia care (MAC)
2 types of IV barbiturates used for induction:
4 types of IV drugs used for induction:
non barbiturates
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:
surentanil citrate
meperidine hcl
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
epidural 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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