COMP3_Peri-op

Card Set Information

Author:
vanwin
ID:
210838
Filename:
COMP3_Peri-op
Updated:
2013-04-01 23:58:14
Tags:
COMP
Folders:

Description:
nursing competencies
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user vanwin on FreezingBlue Flashcards. What would you like to do?


  1. Patient interviews
    • can be done by multiple members (nurse, OR nurse, surgeon, physician)
    • can be done days before non emergency selective surgery
    • gives patient and family opportunity to ask questions
  2. Pre-op nursing assessment
    • Baseline for later in OR
    • psychological status: coping strategies
    • physiological status
    • labs & tests
    • identify & verify surgical site
    • medications - OTC, RX, supplements and recreational drugs
  3. Past health history
    • medical hx
    • surgical hx & reactions
    • hx of current illness
    • family hx
    • level of understanding
    • answer questions
  4. Pre-op Psychological Assessment
    • use common language
    • anxiety and fear are normal
    • -pain & discomfort
    • -multaliation/ body image
    • -anesthesia
    • -life disruption
    • -death
    • Hope!
  5. Pre-op physical assessment
    • respiratory
    • cardiovascular
    • urinary
    • immune
    • hepatic
    • nervous
    • endocrine
    • fluids & electrolyte
    • nutrition
  6. Pre-op Teaching
    • talk just enough, don't over explain or vague words
    • tell them what to expect (ex: setting of OR)
    • what happens in PACU
    • possible complications
    • skin prep might discolor skin but will wash off
    • possible drains & bandages
    • possible monitoring devices
    • PCA/ epidural use
    • incentive spirometer
  7. Consent for surgery
    • must be obtained for all non life threatening emergency surgeries
    • obtained by doctor or person performing surgery: explain procedure, risks, benefits, & alternatives
    • If pt is unable to consent/minor, legal guardian signs
    • not needed if: life threatening and pt is unable to consent, no relatives present, must be documented
  8. Physical preparations & medications
    • wear hospital gowns, nothing else
    • accurate ID band
    • no makeup, nail polish
    • no jewlery
    • take of prosthetic (even contacts)
    • leave hearing aids in to hear instructions
    • start IV
    • complete check list
    • Medications: amnesic effect, decrease N/V & secretions
  9. Physical OR environment
    • Unrestricted area:
    • - street clothes
    • - office, education, locker rooms
    • Semirestricted:
    • - scrubs, OR shoes, hair cover
    • - hallways, utilities and supplies
    • Restricted:
    • - scrubs, OR shoes, hair cover & mask
  10. Surgical team
    • RN/ circulating nurse:
    • - traffic cntrl
    • -pt advocate
    • - documentation
    • -contacting family
    • -environment
    • Scrub nurse/Tech/LVN:
    • - hand instruments to surgeon
    • - sterile instrument area
    • MD assisstant/ RN 1st assist:
    • - assist with surgery
    • -experienced surgical rn
    • Anesthesia Care Provider:
    • - CRNA/ anesthesiologist
    • Surgeon:
  11. Management before surgery
    • In OR
    • Baseline assessment data: physiological & psychological
    • position patient: avoid pressure on bony surfaces
    • allergies: chart review
  12. Management during surgery
    • patient advocate
    • safety precautions
    • transfer patient
    • position patient
    • make sure surgical site is dry
  13. classification of anesthesia
    • minimal: local
    • moderate: "conscious" able to respond but wont remeber
    • deep: hard to arouse, still breath & swallow
    • anesthesia: sedated, can't breath/ swallow
  14. Gerentologic considerations
    • Pad patient more
    • decreased skin elasticity
    • they react differently to medications
    • hypothermia: use bear huggers on legs
  15. Catastrophic events in OR
    • respiratory/ cardiac arrest
    • massive blood loss
    • anaphylaxis to drugs/ antibiotics/ anesthesia
    • malignant hyperthermia, rare but serious, muscles become rigid before they die.
    • fire
  16. New & future surgical considerations
    • decrease NPO time
    • bloodless surgery
    • robotics surgery
    • telesurgery
  17. Potential post op respiratory problems
    • Obstructive airway:
    • - tongue, laryngeal spasms, laryngeal edema, retention of secretions
    • Bronchiolspasms: SOB/ Wheezing
    • Hypoxia:
    • - atelectasis
    • - pulmonary edemia
    • - aspiration of gastric contents
    • hypoventilations
    • Nursing Implications:
    • - turn pt Q2H
    • - position pt correctly
    • - deep breathing
    • - O2 supplement
  18. Potential post op cardiovascular problems
    • HTN, hypotention, hemorrhage
    • cardiac; MI, dysrhythmias, cardiac tamponade
    • Nursing Implications
    • -PACU: give O2, assess & correct fluids
    • -unit: monitor I&O, wear compression stockings, watch for syncope/ orthostatic hypotension
  19. Potential post op neuro/psychological problems
    • Delirium b/c
    • - alcoholic withdrawl
    • - hypoxia
    • delayed emergence
    • - normally frequent upon older population
    • - sluggish & confused
    • cognition- decrease concentration & memory
    • anxiety & depression
  20. Potential post op pain & discomfort
    • Cause:
    • - traumatized skin
    • - muscle spasms
    • - position during surgery
    • - internal devices
    • - movement
    • - anxiety & fear
    • Nursing implications:
    • - assess & reassess frequently
    • - analgesics
    • - transition from opiod to non opioid
    • - PCA/ epidural pump
  21. Potential post op Alterations in temperature
    • Hypothermia
    • first 48hrs
    • < 100.4: surgical stress
    • >100.4: respiratory distress
    • after 48hrs, possible infections
    • Nursing implications:
    • passive warming - blankets
    • active warming
    • assess Q4H first 48 hrs.
  22. Potential post op GI problems
    • hiccups
    • Nausea/Vomitting
    • Abdominal distension
    • decrease peristalsis( thats why NPO first during post op)
    • Nursing implications:
    • antiemetic medication
    • assess bowel sounds
    • IV fluids for dehydrations
    • prevent aspirations
    • NG tube to decompress stomach
    • flatulation- turn to the right
  23. Potential post op urinary problems
    Acute urinary retention is more likely to happen after abd surgery

    Nursing implications: encourage normal positioning for voiding

What would you like to do?

Home > Flashcards > Print Preview