Term
| 3 stages of total surgical episode |
|
Definition
Preoperative
Intraoperative
Postoperative |
|
|
Term
|
Definition
| prior to surgery (Decision for surgery up to the arrival to OR) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| immediately following the surgery |
|
|
Term
| PERIOPERATIVE CARE is ______-______ not task oriented! |
|
Definition
|
|
Term
| Who is part of the collaborative team for perioperative care? |
|
Definition
| Client/Family, Surgeon, Nurse(s), Anesthesia Care Provider |
|
|
Term
| Goals of perioperative care? |
|
Definition
| Client Safety, promoting most optimal recovery |
|
|
Term
| When assessing psychosocial/emotional assessment of a perioperative patient you assess? |
|
Definition
- Patient/family expectations
- Stressors & Coping mechanisms
- Anxiety/fear/hope
- Never deny or minimize
- Cultural or Spiritual beliefs: Conflicts?
- Referrals: Social Worker, Spiritual or Cultural advisor, Psychologist, Financial Advisor, Caregiver |
|
|
Term
| When assessing health status assessment of a perioperative patient you assess? |
|
Definition
Past health history:
- Surgeries/anesthesia(s)
- Surgical Risk Factors
- Review of body systems (menses?)
- Pain history
- Chronic conditions (MI, arthritis, etc.) |
|
|
Term
|
Definition
ABCDE mnemonic
allergies (intolerances),
bleeding,
cortisone/steroid use,
diabetes,
emboli |
|
|
Term
| When reviewing the neurologic system you should review... |
|
Definition
| Deficits in cognitive function, disease (palsy, stroke) |
|
|
Term
| When reviewing the cardiac system you should review... |
|
Definition
|
|
Term
| When reviewing the respiratory system you should review... |
|
Definition
| Chronic respiratory diseases or infections (COPD, URI) |
|
|
Term
| When reviewing the GI/GU/Renal system you should review... |
|
Definition
- Renal or urinary tract diseases (CKD, UTI)
- Obesity, voiding patterns, last BM, menses |
|
|
Term
| When reviewing the Hepatic system you should review... |
|
Definition
| Risk for clotting abnormalities and toxicity (Jaundice) |
|
|
Term
| When reviewing the Musculoskeletal system you should review... |
|
Definition
| Mobility problems (esp. elderly) |
|
|
Term
| When reviewing the Immune system you should review... |
|
Definition
| Immunocompromised (Corticosteroids, AIDs/TB, Hepatitis C) |
|
|
Term
| When reviewing the endocrine system you should review... |
|
Definition
| Diabetes, Thyroid dysfunction (BG, thyroid medication) |
|
|
Term
| When reviewing the Integumentary system you should review... |
|
Definition
| Rashes, pressure ulcers, tattoos, piercings |
|
|
Term
| While reviewing the systems make sure you also review the ______ status and ___ & ____ status? |
|
Definition
| nutritional, fluid, electrolyte |
|
|
Term
| When doing the review of medications prior to surgery make sure to review... |
|
Definition
- Routine or Intermittent
Coumadin, Insulin, Birth Control pills
Benadryl
- Over-the-counter (OTC)
- ASA, ibuprofen
- Vitamins/Herbals (Vit. E, St. John’s wort,)
- Recreational drugs, abuse, & addiction, including ETOH and Tobacco |
|
|
Term
| What can you ask the patient to do to help make sure that your review of medications that the patient is on is correct? |
|
Definition
| Ask clients to bring the medication bottles with them |
|
|
Term
| When reviewing allergies and intolerances what is important to ask about? |
|
Definition
| Ask what the specific reaction was |
|
|
Term
| What are some food/other allergies associated with latex allergies? |
|
Definition
| Bananas, avocados, potatoes, rubber, peaches, eggs, chestnuts |
|
|
Term
| Common lab and diagnostic tests prior to surgery? |
|
Definition
- CBC, electrolytes, renal and liver function tests, albumin, blood glucose, hCG
- U/A
- CXR, ECG
- Type and Crossmatch
- PTT, PT/INR
- ABGs, pulse oximetry
- Methicillin-resistant Staphylococcus aureus (MRSA) test |
|
|
Term
| Preoperative Teaching increases... |
|
Definition
|
|
Term
| Preoperative Teaching reduces... |
|
Definition
| fear, anxiety, stress, pain, and vomiting |
|
|
Term
| 3 types of information for Preoperative Teaching |
|
Definition
- Sensory - Explain timelines and describe environments patient will be in
- Process - Preparations before surgery
- Procedural -NPO status, Pain assessment & management |
|
|
Term
| How can you evaluate learning? |
|
Definition
|
|
Term
| If you don't ____ then it didn't happen. |
|
Definition
|
|
Term
| Pre-Op Teaching for Open Abdominal Surgery |
|
Definition
- Wound care
Sterile dressing vs. Clean dressing (“No Touch technique”)
- Deep breathing & coughing exercises:
Abdominal Splinting
Incentive Spirometry (I.S.)
- Leg/foot exercises for prevention of thrombi
Calf Pumping
SCD’s/Kendall Foot pumps
- Turning/positioning/ambulation |
|
|
Term
| Who's responsibility is it to obtain informed consent? |
|
Definition
|
|
Term
| What is the responsibility of the RN concerning the informed consent? |
|
Definition
| Confirm the consent has been signed. (May witness signature, verify understanding) |
|
|
Term
| Types of common pre-op medications? |
|
Definition
| Beta-Blockers, Benzodiazepines, opioids, anticholinergics, antiemetic's, H2- receptor blockers, antibiotics, antidiabetics |
|
|
Term
| Why are beta blockers prescribed prior to surgery? |
|
Definition
|
|
Term
| Why are benzodiazepines prescribed prior to surgery? |
|
Definition
| for their sedative/amnesic affects |
|
|
Term
| Why are opioids prescribed prior to surgery? |
|
Definition
| to decrease pain and anesthetic requirement |
|
|
Term
| Why are anticholinergics prescribed prior to surgery? |
|
Definition
| to decrease oral secretions |
|
|
Term
| Why are antiemetic's prescribed prior to surgery? |
|
Definition
| to decrease nausea/vomiting, gastric emptying |
|
|
Term
| Why are h2-receptor blockers prescribed prior to surgery? |
|
Definition
| to decrease gastric volume & HCL acid secretion, increases pH |
|
|
Term
| Why are antibiotics prescribed prior to surgery? |
|
Definition
| to prevent post-op infections |
|
|
Term
| Why are antidiabetics prescribed prior to surgery? |
|
Definition
| to stabilize blood glucose |
|
|
Term
| What are the improvement measures that the Surgical Care Improvement Project focuses on? |
|
Definition
- Prophylactic administration of appropriate antibiotic within 1 hour of incision
- Cefazolin – short half-life, rapid penetration into tissues, low toxicity
- Discontinuation of antibiotic 24 hours after surgery
- VTE prophylaxis 24 hours prior to and after surgery. |
|
|
Term
| Who came up with the SCIP and what does it stand for? |
|
Definition
TJC & Center for Medicare/Medicaid
Surgical Care Improvement Project |
|
|
Term
| Who came up with the universal protocols for surgery? |
|
Definition
|
|
Term
| What are the 3 components of universal protocols? |
|
Definition
UP.01.01.01 Pre-procedure verification
UP.01.02.01 Site marking
UP.01.03.01 Time-out procedure |
|
|
Term
| The components of pre-procedure verification? |
|
Definition
-Correct documentation
-Patient and documents identified correctly
- Verbal review and clarification of patient’s expectations and team’s understanding
- Must occur more than one time |
|
|
Term
| “Time-Out” procedure is... |
|
Definition
-immediately before procedure begins
-Agreement on the procedure by all surgical team members |
|
|
Term
| What is on the pre-op checklist? |
|
Definition
-History & Physical on chart
-NPO Last meal/intake: ___________
-Patient voided
-Pregnancy Test, if applicable
-Undressed and in gown
-Cosmetics, nail polish, acrylic nails
removed
-Prosthetics removed (dentures, wig, glasses, contacts, etc.)
-Valuables secured
-Pre-op teaching completed
-Pre-op prep/orders done
-Surgical site marked
-Procedure confirmed |
|
|
Term
| What is the timeframe for the Intraoperative "Intra-op" period? |
|
Definition
Arrival to O.R. (Surgery) to
completion of the procedure |
|
|
Term
| Who are the people that make up the surgical team? |
|
Definition
-Surgeon
- Surgical Assistant or RNFA
- Anesthesiologist/CRNA
- Circulating RN
- Surgical technician/scrub nurse |
|
|
Term
| Responsibilities of surgeon in surgery? |
|
Definition
| Team leader. Performs procedure |
|
|
Term
| Responsibilities of surgical assistant or RNFA in surgery? |
|
Definition
| Exposes the operative site, retracting tissue, sponging or suctioning wounds, suturing |
|
|
Term
| Responsibilities of anesthesiologist/CRNA in surgery? |
|
Definition
- Pre-anesthesia assessment
- IV’s, meds, anesthesia, continuous physiologic monitoring |
|
|
Term
| Responsibilities of Circulating RN in surgery? |
|
Definition
(unsterile activities)
- Coordinates and manages care before, during, after surgery.
- Oversees physical aspects of the OR
- Foley, surgical scrub prep, sponge count
- Assist patient positioning, gathers equipment
- Documentation |
|
|
Term
| Responsibilities of Surgical technician/Scrub nurse in surgery? |
|
Definition
| - Handles sutures, instruments, other equipment immediately adjacent to sterile field |
|
|
Term
| Identify important precautions the Intraoperative nurse takes to ensure client safety in the Operating room? |
|
Definition
- identify the right patient
- position client properly
- prevent wrong site surgery
- check equipment for safety
- count the supplies used during surgery
- maintain surgical asepsis |
|
|
Term
| What are the effects of general anesthesia? |
|
Definition
- Loss of sensation & Consciousness
example: Dissociative anesthesia – Ketamine |
|
|
Term
| What are the effects of regional anesthesia? |
|
Definition
Loss of sensation in a particular region
Example: Nerve or spinal blocks, epidurals |
|
|
Term
| What are the effects of local anesthesia? |
|
Definition
Loss of sensation at surgical site
example: Lidocaine |
|
|
Term
| What are the effects of moderate sedation and example(s)? |
|
Definition
Pt. responds but is groggy verbal, follows commands, maintains own airway.
Examples: IV narcotics and anti-anxiety meds
Versed, diazepam, Morphine & Fentanyl |
|
|
Term
| What is used with regional or local anesthesia? |
|
Definition
| Monitored anesthesia care (MAC) |
|
|
Term
| Examples of when moderate sedation is used? |
|
Definition
| Closed reduction of fracture, Colonoscopy, burn dressings, Cardiac Catheterization |
|
|
Term
| What are the components of the setup for moderate sedation? |
|
Definition
-Consent
-Universal protocol
-Same assessments/teaching
-Fully monitored
-Nurse does the med admin., IVs, and airway monitor
-O2 administered |
|
|
Term
| What are some reversal agents for moderate sedation? |
|
Definition
- Narcan (naloxone) – opioid antagonist
- Romazicon – benzodiazepine antagonist |
|
|
Term
| Phases of general anesthesia |
|
Definition
Preinduction→Induction→Maintenance→
Emergence |
|
|
Term
| What type of anesthesia requires mechanical ventilation? |
|
Definition
|
|
Term
| What type of anesthesia causes patients to be sedated and paralyzed? |
|
Definition
|
|
Term
| What type of anesthesia causes skeletal muscle flaccidity or paralysis? |
|
Definition
|
|
Term
| What type of anesthesia is used to control pain? |
|
Definition
|
|
Term
| What are some common causes of complications of anesthesia? |
|
Definition
- Cardiac depression
- Anaphylaxis
- CSF leakage r/t spinals, epidurals
- anesthesia awareness
- malignant hyperthermia |
|
|
Term
| What is a Hereditary, life-threatening reaction to general anesthetic (neuromuscular agents)? |
|
Definition
|
|
Term
| What is the pathophysiology of malignant hyperthermia? |
|
Definition
| altered mechanisms of calcium function in skeletal muscle cells. Disruption of calcium causes symptoms of hypermetabolism, increases muscle contraction, hyperthermia and damage to the CNS. |
|
|
Term
| Signs and symptoms of malignant hyperthermia? |
|
Definition
| Muscle contractions (early sign -Jaw), hyperthermia (late sign > 107 F), perfuse perspiration, hypoxemia, lactic acidosis, and hemodynamic instability leading to death |
|
|
Term
| What is the treatment for malignant hyperthermia? |
|
Definition
| dantrolene (Dantrium) - acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells. |
|
|
Term
| Phases of Post anesthesia Care |
|
Definition
1 – Arrival to PACU
2 – Arrival to surgical unit or SDS
3 – Discharge to home or extended care; post-op phase may last weeks, months, or years |
|
|
Term
| What is done in the phase 1 of PACU? |
|
Definition
-Report
- Procedure type, type of anesthesia, medications given, I&O, estimated blood loss (EBL) vital signs, significant occurrences during surgery, dressings, drains, tubes
- Written PACU/Post-op orders
-Intensive monitoring
-Priority
ABC’s! |
|
|
Term
| What is the most common obstruction to the airway in the PACU? |
|
Definition
|
|
Term
| What are some interventions to help keep a patent airway? |
|
Definition
| Jaw thrust, suctioning, repositioning |
|
|
Term
| Don’t be fooled; pay close attention to ______ __________ changes in Vital Signs |
|
Definition
|
|
Term
| In phase 1 in the PACU vital signs should be taken every _____ minutes and every ___ minutes. |
|
Definition
|
|
Term
| When a patient is first in the PACU and before they are awake what ... what position should the patient be placed in? |
|
Definition
| Lateral recovery position |
|
|
Term
| When a patient is in the PACU and is conscious... what position should the patient be placed in? |
|
Definition
|
|
Term
| What is atelectasis and the etiology? |
|
Definition
| alveolar collapse and retained secretions or hypoventilation |
|
|
Term
| Signs and symptoms of atelectasis? |
|
Definition
| diminished/absent lung sounds & s/s of hypoxia |
|
|
Term
| What is the etiology of hypoxemia? |
|
Definition
| atelectasis (most common), pulmonary edema, aspiration, bronchospasm |
|
|
Term
| Signs and symptoms of hypoxemia? |
|
Definition
restlessness, SP02 < 90%, SOB, ↑ HR,
↑ or ↓ B/P, diaphoresis and cyanosis (late), bradycardia (very late), prolonged capillary refill |
|
|
Term
| What is etiology of hypoventilation? |
|
Definition
| CNS depression, decreased respiratory muscle tone |
|
|
Term
| What are the signs and symptoms of hypoventilation? |
|
Definition
Hypoxemia and hypercapnia
|
|
|
Term
|
Definition
|
|
Term
| What is the etiology of pneumonia? |
|
Definition
| Alveolar inflammation caused by infection, aspiration, or atelectasis |
|
|
Term
| Signs and symptoms of pneumonia? |
|
Definition
| Crackles in affected lobes, fever, chest pain, productive cough, ↑WBC’s |
|
|
Term
| What is a pulmonary embolism and what is the etiology? |
|
Definition
embolic obstruction of a pulmonary artery
Abnormal cardiac rhythms, DVTs (blood), fractures of major bones (fat), air embolism (central lines) |
|
|
Term
| What are some prevention measures for pulmonary embolisms? |
|
Definition
- treat risk factors
- prevent DVT's |
|
|
Term
| Signs and symptoms of a pulmonary embolism? |
|
Definition
| Chest pain, SOB, ↑HR/RR, ↓B/P, pallor, cyanosis, ↓SP02, death |
|
|
Term
| What are interventions for pulmonary embolisms? |
|
Definition
| 02, anticoagulation, monitoring, semi-Fowler’s position |
|
|
Term
| What are some nursing interventions to prevent respiratory complications? |
|
Definition
-Oxygen therapy
-Cough and deep breathing
-Change patient position every 1–2 hours
-Early mobilization
-Adequate hydration
-Parenteral or oral
-Chest physical therapy
-Pain management
-reversal of opioids or use of mechanical ventilation (Hypoventilation)
-antibiotics, suction p.r.n. (Pneumonia) |
|
|
Term
| What is caused by a rapid, large loss of blood? |
|
Definition
|
|
Term
| What are the signs and symptoms of hemorrhage/shock? |
|
Definition
| restlessness, ↓LOC, ↓B/P, ↑HR & RR, weak pulse, pale, diaphoretic, ↓UOP (< 20 mL/hr |
|
|
Term
| common interventions for hemorrhage/shock? |
|
Definition
-External bleeding?
-Notify surgeon
-02, ↑ IV fluids, blood products, Trendelenburg
-Return to OR?
-Reassess patient
-Serial lab analysis |
|
|
Term
| What is venous thromboembolism and the etiology? |
|
Definition
clot formation & inflammation of leg veins
Etiology – ↓venous return or ↑venous stasis |
|
|
Term
| What are some preventive measures you can take to prevent venous thromboembolism? |
|
Definition
| TED hose, SCD’s, leg/ankle exercises, & early ambulation |
|
|
Term
| What are the signs and symptoms venous thromboembolism? |
|
Definition
| Pain (crampy/achy), redness/heat, swelling/edema, + Homan’s sign |
|
|
Term
| What are the interventions recommended for venous thromboembolism? |
|
Definition
| elevation, bedrest ?, anticoagulation, avoid any position that ↓’s venous return and ↑’s venous stasis |
|
|
Term
| What is Lovenox (enoxaparin) action? |
|
Definition
| Binds to antithrombin III helping it inactivate factor X and thrombin; prevent conversion of fibrinogen to fibrin |
|
|
Term
| What is therapeutic action of lovenox? |
|
Definition
|
|
Term
| What is the correct procedure for administration of an anticoagulation? |
|
Definition
-Confirm dose w/ second nurse
-Route, angle of needle, rotation of sites in abdomen
-Aspiration?, Bubble?
-Assessment
-Labs: RBC’s, Hgb, Hct, Platelets
-Patient teaching |
|
|
Term
| What is paralytic ileus and the etiology? |
|
Definition
| absent bowel motility and manipulation of bowel (trauma), anesthetics, opioids |
|
|
Term
| What are the signs and symptoms of paralytic ileus? |
|
Definition
| absent bowel sounds, abdominal distention, absence of flatus or BM, N/V |
|
|
Term
| What are the treatments and medications used for paralytic ileus? |
|
Definition
-Treatment – NPO, NG tube, IVs for hydration & nutrition, I&O, ↑activity
-Medications
-GI stimulants (Reglan)
-Histamine H2 Receptor antagonists (Pepcid, Zantac)
-Proton pump inhibitors (Protonix, Nexium, Prevacid, Prilosec) |
|
|
Term
| What is the goal for BM's after surgery? |
|
Definition
| Goal: BM within 48 hours after surgery |
|
|
Term
| What is the etiology of constipation? |
|
Definition
| Etiology - ↓activity, ↓gastric mobility (medications), dehydration, decreased intake of solid food |
|
|
Term
| What are the recommended treatments for constipation? |
|
Definition
-Treatment
-↑ activity,↑ fiber intake, ↑fluid intake, stool softeners and laxatives
-Privacy/time
-Assess and document |
|
|
Term
| The goal is for a patient to urinate with _____ after surgery. |
|
Definition
|
|
Term
| What makes a patient at risk for urinary retention? |
|
Definition
| opioids, anesthetics, and Anticholinergics |
|
|
Term
| What are the signs and symptoms of urinary retention? |
|
Definition
| distended bladder, drum-like sound over bladder, lower abd. pain, restlessness, diaphoresis, ↑B/P |
|
|
Term
| What is the recommended treatment for urinary retention? |
|
Definition
-Bladder scan
-Position? Privacy?
-Warm H20
-Catheterization |
|
|
Term
| What do you assess to check for wound infection? |
|
Definition
-Assess V.S., labs, pain
- Tenderness, malaise, chills, ↑temp, ↑WBC, HR? B/P?
-Assess wound
-Effect of position changes
- Heat, redness, edema |
|
|
Term
| What are some interventions you can do to prevent wound infection? |
|
Definition
-Maintain aseptic/sterile technique during dressing changes; Glycemic control
-Proper administration of antibiotics give on time |
|
|
Term
| Who are at risk of wound dehiscence? |
|
Definition
At risk:
-Obesity, Poor wound healing
-Infection, Auto-immune illnesses
-Malnutrition |
|
|
Term
| What position do you place someone in that has a wound dehiscence? |
|
Definition
| Place in Low-Fowler’s and lie quietly |
|
|
Term
| What is one way to prevent abdominal wound dehiscence? |
|
Definition
|
|
Term
| What nursing actions are initiated if a client eviscerates a postoperative wound? |
|
Definition
- position the patient (low folwers knees bent)
- return the patient to bed
- cover with saline soaked gauze
- notify the surgeon immediately
- keep the patient calm
- prepare the patient for emergency surgery |
|
|
Term
| When you assess a dressing what are you looking for? |
|
Definition
| Location, intact, drainage |
|
|
Term
| When you assess a drainage what are you looking for? |
|
Definition
Look under patient!
-Amount
-Consistency
-Color – sanguineous,
serosanguineous, serous, purulent
-Odor |
|
|
Term
| Confusion is a sign of _____________ until ruled out. |
|
Definition
|
|
Term
| Methods of delivery of Pain Relief after surgery |
|
Definition
-Analgesics
-IM, IV push, PO
-Spinal/Intrathecal
-Epidural
-Patient Controlled Anesthesia (PCA |
|
|
Term
| pain management is complex in a patient with ___________ _______ and they may require higher amounts of pain relief during periop period |
|
Definition
|
|
Term
| What are the advantages of patient controlled anesthesia? |
|
Definition
| Early ambulation, better pain management, greater patient satisfaction |
|
|
Term
| What teaching do you need to provide a patient about patient controlled anesthesia? |
|
Definition
-Self-administer before pain intensity is intolerable
-Mechanics of use of PCA
-Cannot “overdose”
-Dose can be increased if inadequate pain relief |
|
|
Term
| Common opioids used after surgery? |
|
Definition
| Morphine, Demerol, Fentanyl, Hydromorphone, Hydrocodone, Oxycodone |
|
|
Term
| What is the action of opioids? |
|
Definition
| Binds to opiate receptors in the CNS and changes the patient’s perception and reaction to pain; causes CNS depression. Decrease in pain severity. |
|
|
Term
| What are the nursing implications for opioid use? |
|
Definition
| Pain assessment, LOC/sedation level |
|
|
Term
| What are some Non-Pharmacologic Methods of Pain Relief? |
|
Definition
-Repositioning
Minimum every 2 hours
-Use pillows
-Reduce anxiety – massage, deep breathing
-Reduce environmental stimulus
-Distraction
-Music, relaxation exercises
-Social interaction
-Guided imagery, aromatherapy |
|
|
Term
| Ways to prevent alterations in temperature? |
|
Definition
-Passive warming
-Active warming
-Oxygen therapy
-Opioids
-Meticulous asepsis
-Coughing/deep breathing |
|
|
Term
| What is required to be discharged from PACU? |
|
Definition
-Awake, easily arousable, or at baseline
-Gag reflex present
-Stable V.S.
-No excess bleeding or drainage
-No respiratory depression
-SP02 >90%
-Review Post-op Assessment
-Respiratory, Cardiac, Neuro, Pain, Temp, GI/GU, Integumentary |
|
|
Term
| What is ABCDEFGH stand for? |
|
Definition
Airway
Breathing
Circulation
Dressing/Drains/Disability
Environment
Full Set of Vitals
Give Comfort Measures
Head to toe assessment |
|
|
Term
| What is required for discharge from same day surgery? |
|
Definition
-Alert and oriented
-No respiratory distress
-Able to cough, swallow, and walk
-No vomiting
-Has voided
-Mild or minimal pain and has received no pain med in the last 30 minutes
-No active bleeding
-Has responsible driver for transport home
-Discharge instructions given and understood |
|
|
Term
| What is needed to be given as discharge instructions? |
|
Definition
-Diet/Hydration
-Drink 6 to 8 glasses of liquid/day
-Activity
-Medications
-Medication Reconciliation
-Wound Care
-Drain and tube care if any
-Follow-up care
-What to report to the HCP; when to return for F/U care |
|
|
