PeriOperative

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Author:
jtisby
ID:
206119
Filename:
PeriOperative
Updated:
2013-03-12 19:37:26
Tags:
PeriOperative WWCC W13
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Questions are Learning Outcomes/Objectives
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  1. Explain the goals of perioperative nursing
    • -Client safety
    • -Most optimal recovery
  2. Describe essential components of preoperative nursing:

    • Assessment:physical, psychosocial, health Hx, Head-2-Toe, medications, allergies
    • Diagnostic Tests:CBC, U/A, CXR, ECG, PT/PTT/INR, ABGs, pulse Ox
    • Teaching: 3 types - Sensory, Procedural, Process
    • Informed Consent:understood by Pt, volentary (signed b4 being medicated), confirm signage, witness signature
  3. Develop a preoperative teaching plan for a client undergoing open abdominal surgery.
    (ND & interventions)
    • -NDs:Deficient knowledge, Anxiety, Anticipatory grieving, Risk for injury
    • -wound care
    • -deep breathing & coughing exercises, I.S.
    • -leg/foot exercises 2 prevent thrombi/DVTs
    • -turning/positioning/ambulation
  4. Describe the action, therapeutic effect, and nursing implications of medications
    administered during the preoperative period.
    • -Antibiotics: prevent post-op infections
    • -Antidiabetics: stabilize blood sugar
    • -Anticholinergics: decrease oral secretions
    • -Anti-emitics: decrease nausea/vomiting
    • -Beta Blockers: manage HTN
    • -Benzodiazepines: sedative
    • -H2 receptor blockers: decrease gastric vol. & secretions
    • -Narcotics/Opioids: treat pain,
  5. Identify the surgical team (OR team) and describe their role in client safety.
    • Surgeon:team leader, performs procedure
    • Surgical assistant: exposes tissue, sponging, suctioning, suturing
    • Anesthesiologist: focused assessment, IVs, meds, anesthesia, continuous monitoring
    • Circulating RN:coordinator, documentation
    • Surgical tech/Scrub nurse:handles sutures, instruments, equipment
  6. Types of anesthesia.
    • -general
    • -regional
    • -local anesthesia
    • -monitored anesthesia care (MAC)
  7. Describe features of Conscious Sedation
    • -Pt responsive
    • -IV narcotics & anti-anxiety meds
    • -strict protocols
    • -special training
    • -Ex: closed reduction of fracture, colonoscopy, burn dressings cardiac catheterization
  8. Goals of Conscious sedation
    • -Priority is airway
    • -keep Pt. moderately sedated
    • -Pt maintains airway, follows commands, verbal
    • -reversal agents: Narcam, Romazicon
  9. Describe the role of the nurse related to conscious sedation and explain potential risk factors
    • -Consent
    • -Universal protocol
    • -Assessments/teaching
    • -monitoring VS
    • -med admin, IVs, & airway monitoring
    • -O2 admin
  10. Measures to maintain client safety during the intraoperative phase
    -Infection control

    -Universal Protocol: time-out 4 final assessment
  11. Explain the role of the PACU nurse
    • -Goal: to discharge from medical care
    • -ABC priority
    • -Assessment: LS, RR, SPO2, RR quality
    • -Interventions: jaw-thrust, positioning, suctioning
    • -Report¬†
    • -Intensive monitoring: cardiac/resp.
    • -airway obstruction?
  12. Name 5 Post-Op Respiration complications
    • -Atelectasis: alveolar collaspe
    • -Hypoxemia: pulmonary edema, aspiration
    • -Hypoventilation: CNS depression
    • -Pneumonia: alveolar inflammation
    • -Pulmonary embolism (PE): obstr of plumonary artery
  13. Name 2 Post-Op Cardio complications
    • -Hemorrhage/shock: rapid loss of large amts of blood. (EBL)
    • -Thrombophledits: clot formation and inflammation.¬†
    • -Homan sign: pain on forced dorsi-flex of foot
  14. Interventions for Post-Op Respiratory complications
    • -o2
    • -Deep breathe & coughing
    • -IS
    • -turning/repositioning
    • -early amblulation
    • -antibiotics, IV fluids, anticoagulation
  15. Interventions for Post-Op Cardio complications
    • -o2
    • -IV fluids
    • -Blood products
    • -positioning (Trendelenburg-supine/legs loft)
    • -anticoagulation
  16. Anticoagulation medication
    • Lovenox (enoxaparin)
    • -theraputic: anticoagulant
    • -pharmacologic: antithrombotic
    • -MOA: binds to antithrombin 3 =>deactivate factor X and thrombin => prevents conversion of fibrinogen to fibrin
    • -Dangerous: does confirmed by 2nd nurse
  17. Name 6 commonly used Pain Medications
    • -therapeutic: opioid analgesic
    • -pharmacologic: opioid agonist
    • -action:binds to opiate receptors in CNS changing Pt's perception/reacion to pain
    • -Morphine
    • -Demerol
    • -Fentanyl
    • -Hydromorphone
    • -Hydrocodone
    • -Oxycodone
  18. Acute pain
    • Acute
    • -sudden onset
    • -less than 6 months
    • -mild to severe
    • -usually identifiable
    • -decreases and/or resolves overtime
    • -elevated HR, RR, BP, anxiety, agitation
  19. Chronic pain
    • -gradual or sudden onset
    • -greater than 6 months
    • -cause may be unknown
    • -mild to severe
    • -waxes and wanes
    • -flat affect, fatigue, social ioslation
  20. Pain Assessment
    • -P provokes
    • -Q quality
    • -R region
    • -S severity
    • -T timing
  21. ABCDEFG
    • Airway
    • Breathing
    • Circulation
    • Dressing/Drains & Disability
    • Environment
    • Full set of VS
    • Give comfort measures
  22. Methods of pain reilfe
    • -Repositioning
    • -reduce anxiety
    • -reduce environmental stimulus
    • -distraction
    • -medication

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