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A nurse functions as a (an)?
- an advocate
- and a promoter of health
Perioperative nursing places special emphasis on?
- and patient education
When does the preoperative period begin and end?
The preoperative period begins when the patient is scheduled for a surgical procedure and ends when the patient is transfered to the OR (operating room)
When does the intraoperative period begin and end?
The intraoperative period begins when patient enters the surgical suite and end at the time of transfer to the postanesthesia recovery area, same day surgery (SDS), or intensive care unit (ICU)
When does the postoperative period begin and end?
Postoperative starts at the completion of surgery and transfer of patient to postanesthesia care unit (PACU), same day surgery (SDS), or intensive care unit (ICU)
Determine the diferent reasons/purposes for surgery?
- Diagnostic = determine the origin and cause of a disorder
- ( Breast biopsy, exploratory laparotomy or Athroscopy)
- Curative = resolves a health problem be removing or repairing the cause.
- (Appendectomy or hysterectomy)
- Pallitive = Relieves symptoms but does not cure it
- (colostomy, nerve root resection, tumor debulking)
- Restorative = Improves functional ability
- (total knee replacement, finger reimplantation)
- Cosmetic = enhances personal appearnce
- (Liposuction, breast implants, scar removal or rhinoplasty)
Determine the different type of surgery?
- Elective = Planned and nonacute type of surgery
- (cataract removal, hernia repair, total joint replacement or hemorrhiodectomy)
- Urgent = Life threatening if not done within 24-48hr
- (Bladder or intestinal obstruction, kidney stones, bone fractures, eye injury or acute cholecystitis)
- Emergent = immediate intervention due to life threatening issues.
- (gun shot or stab wound, compound fracture, severe bleeding, AAA, or apendectomy which is also curative)
Determine the different degree of risk or extent of surgery?
Surgery can be Minor
with out significant risk with the use of local anesthetic. Surgery can also be Major
with greater risk and longer and more extensive.
- Extent of surgery can either be Simple such as simple/partial mastectomy (only the involved area)
- Radical surgery beyond the obviously involved area such as a complete radical mastectomy or hysterectomy.
- MIS- minimally invasive surgery is performed in a body cavity or area through an endoscope.
How does alcohol, drug and substance abuse affect a patients response to surgery?
- Excessive alcohol and illicit substance use can
- alter the patient's responses to anesthesia and pain medication
What can alcohol withdrawal before surgery lead to?
Older patients are at risk for dehydration because?
Of reduced muscle mass and body water
The normal aging process put's older patient's at risk due to ?
- Decreased Immune system functioning
- and delays of wound healing
What would be the Nursing intervention for the aging adult with decreased peripheral circulation?
- Monitor vital signs
- peripheral pulses
- and capillary refill
- Rational; Having baseline helps prevent deviations
What would be the nursing intervention for the aging patient with decreased cardiac output or increased blood pressure?
- Determine activity level
- and note when the patient tires
- Rational; Knowing the limits helps to prevent fatigue
What would be the nursing intervention for the aging patient with reduced respiratory vital capacity or loss of lung capacity?
- Teach coughing
- and deep breathing exercises
- Rational; Pulmonary exercises help prevent pulmonary complications such as acteletasis or pneumonia
What would be the nursing intervention for the aging patient with decreased oxygenation of blood?
- Monitor respirations
- and breathing efforts
- Rational; Because having a baseline helps detect deviations
What would be the nursing intervention for the aging patient with reduced ability to excrete waste products or a decline in glomerular filtration rate?
- Assess overall hydration
- Monitor electrolyte status
- Rational; (Ongoing assessment helps detect fluid and electrolyte imbalances and decreased renal function)
What would be the nursing intervention for an aging patient with decreased blood flow to kidneys or Nocturia common?
- Monitor intake and output
- Rational; (Ongoing assessment helps detect fluid and electrolyts imbalances and decreased renal function.)
- Assist frequently with toileting needs, especially at night Rational:( frequent toileting helps reduce incontinence and falls.)
Before surgery the nurse is concerned about the patient's headaches, anxiety, insomnia,tachycardia, hypertension, and instructs him/her to discontinue which herb?
Ephedra and Ginseng
Patient has complaint's about dry mouth and dizziness, and has expressed that he/she takes herbs for healthy lifestyle. Which should be of concern?
Patient has completed menopausal stages and does not have asthma, but has a chief complaint of post menopausal bleeding and asthma attacks, which herb is she taking?
What is an acute life threatening complication from use of certain drugs used for anesthesia; beginning in the skeletal muscle causing increased calcium levels and increased matabolism?
Which herb would the nurse want the patient to discontinue and postpone surgery until levels are rechecked, when labs return with increased potassium and sodium levels?
Which herb causes a decrease in potassium levels?
Patient returns from surgery with liver toxicity, but did not receive heavy anesthesia. In the chart it is documented that patient takes herbs for healty lifestydle, which herb(s) would be in question?
- Valerian root
Define dysuria, nocturia and oliguria?
- Dysuria - painful urination
- Nocturia - awakining during the night to urinate
- oliguria - scant amount of urine
Kidney impairment decreases what?
- excretion of drugs and anesthetic agents
- (Body loaded with drugs may make the kidneys go into shock)
What would be the nursing intervention for the aging patient with sensory defects or slower reaction time?
- Orient patient to the surroundings
- Allow extra time for teaching the patient
- Rational; (An individualized preoperative teaching plan is developed on the basis of the patient's orientation and any neurologic deficits.)
What would be the nursing intervention for the aging patient with decreased ability to adjust to changes in the surroundings?
- Provide for patient safety
- Rational; (Safety measures helps prevent fall and injury.)
What would be the nursing intervention for the aging patient with deformities related to osteoporosis or arthritis?
- Assess the patients mobility
- teach turning and positioning
- encourage ambulation,
- and place on fall precaution, if indicated
- Rational; (Interventions help prevent complications of immobility and safety measures help prevent injury.)
Cardiac problems that increase surgical risk include?
- MI within 6 months before surgery
- heart failure
- and dysrhythmias
Why do cardiac problems increase surgical risk? (Rational question)
- Cardiac problems impair the patients ability to withstand; hemodynamic changes and
- Alter the response to anesthesia
What risk is higher in patients with heart problems?
The risk for MI is higher in patients with heart problems
Cardiac assessment includes?
- Listening to heart sounds;
- For rate and regularity
- and abnormalities
Examine patient's hands and feet for?
- peripheral pulses
- capillary refill
- and edema
- (document any abnormalities)
Pulmonary complications are most likely to occur in what type of patients? And why?
- The older patients
- those with chronic respiratory problems
- smokers ; because of smoking and age related lung changes.
Respiratory assessment includes?
- Observation of patient's;
- Rate, rhythm and depth
- Overall respiratory effort
- and lung expansion
- (Document any clubbing of fingertips or cyanosis)Auscultate the lung for any abnormal breath sounds
- (crackles, wheezes or rubs)
What are appropiate identifiers when providing instruction, administering drugs, marking surgical sites and performing any procedure?
Patient name and MRN should be checked at all time before any administration of drugs or nay procedure is preformed. Blood donation gives a special tag to the patient and the donated bag.
Time Out has been adopted to allow for safety of the patient to be acknowledged; patient identity, correct side and site, correct patient position, agreement on procedure and availability of correct implants must be verified by all team members
How does the nurse verify that the patient has given informed consent for the surgical procedure?
- The surgeon is responsible for having the consent form signed before sedation and is given before the procedure.
- The nurses role is to clarify facts that has been presented by the physician and dispel myths that the patient or family may have.
- Nurses are not responsible for detailed information, you verify that the consent is signed and serve as a witness to the signature
What should the presurgical check list contain to be complete and accurate?
- 1. Allergies letex, environmental or medications
- 2. Isolation precaution MRSA, VRE, c-diff
- 3. Side/ site identification form completed4. Pre-Surgical Testing - labs (cbc,hemoglobin & hematocrit, aPTT, PT and glucose) ECG, X-ray, UA
- 5. Vital Signs6. NPO status7. Wt/HT8. Last menstral Period9. Patient's belongings and valuables10. Type and cross match/ blood consent/ autologous11. Voiding or catheter12. antimicrobial prophylaxis faxed to pharmacy13. IV antimicrobials given 0-60 min prior14. Surgical site prep 15. Equipment to go to OR with patient
A patient failing to adhere to NPO status, increases the risk of?
- Aspiration during surgery.
- Surgery can be canceled
Depletion of potassium, vitamin C and B during surgery can directly affect?
- Wound healing
- and blood clotting
What drug are commonly allowed before surgery with sips of water?
- Cardiac drugs
- Respiratory drugs
- Seizure medication
- and hypertension meds
The diabetic patient may receive what on the day of surgery depending on blood glucose levels?
- long acting
- (Based on blood glucose levels)or may be given regular (fast acting) in divided doses on the day of surgery
Patient's that are at greater risk for DVT are?
- Older than 40
- Have cancer
- Have hip fracture or total hip or knee surgery
- Decreased mobility or immobile
- Have spinal cord injury
- Taking oral contraceptives
- Have history of DVT, PE Varicose Veins or Edema
- Decreased cardiac output
Why is deep breathing or diaphragmatic breathing helpful?
- Helps to enlarge chest cavity
- and expand the lungs
Which patient's are good candidates for expansion breathing exercises?
- Patient's with chronic lung disease
- Limited chest expansion
- Patient's having chest surgery
Why are expansion breathing exercises useful?
- helps strengthen accessory muscles
- and loosen secretions
- and maintain adequate air exchange
What is incentive spirometry and why is it useful?
- An instrument used to encourage patient's to take deep breaths.
- It's purpose is to promote complete lung expansion
- and prevent pulmonary problems such as (pneumonia and atelectasis)
What is the proper way to use incentive spirometry?
- Patient is to seal lips tightly around the mouth piece
- Inhale spontaneously
- and hold breath for 3 to 5 seconds for effective lung expansion
Exercises after surgery are to be performed?
- Early in the recovery stage
- and are done with 5 to 10 repetitions each
- every 1 to 2 hours after surgery
- for at least the first 48 hours
Why are antiembolic stockings, sequential compression boots applied? (Rational Question)
- To promote blood flow and
- help to prevent vascular complications