Card Set Information

2013-07-21 00:00:32

Perioperative phases
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  1. This phase begins with the admission of the patient to the perianesthesia care unit (PACU) & continues until the patient's recovery is completed.
  2. Physicians who perform surgical procedures are called_____?
  3. The period when an anesthetic is 1st given until full anesthesia is reached?
  4. This phase begins with the decision to have surgery & ends with transfer of the patient to the operating room
  5. This phase begins when the patient is transferred to the operating room & ends when the patient is admitted to the PACU
  6. An ____ agent is medication (such as narcotics, muscle relaxants, or anti emetics) used with the primary anesthetic agent.
    Adjunct agent
  7. The sudden bursting open of a wound's edges that may be preceded by an increase in serosanguineous drainage is referred to as:
  8. Physicians who administer anesthesia
  9. Causes a loss of sensation hand allows the surgical procedure to be done safely.
  10. Occurs from hypoventilation or mucous obstruction that prevents some alveoli from opening and being fully ventilated.
  11. The removal of necrotic & infected tissue
  12. Body temperature that is below normal range
  13. The viscera spilling out of the abdomen
  14. -Surgery done at request of patient
    -Cosmetic surgery
    Optional surgery
  15. -Surgery planned & scheduled without immediate time constraints 
    -Hernia repairs 
    -joint replacements
    -skin lesion removal
    Elective surgery
  16. -Surgery needed within 24-30 hours
    -Fracture repair
    -Infected gallbladder
    Urgent surgery
  17. -Surgery needed when any delay jeopardizes the patient's life or limb
    -Extremity emboli
    -Ruptured aorotic aneurysm or appendix
    -Traumatic limb amputation, loss of extremity pulse
    Emergency surgery
  18. True or false 

    All medications that patients are taking must be reviewed preoperatively.
  19. True or false
    Most anticoagulants, such as warfarin (coumadin) do not need to be stopped before surgery
    • False
    • The surgeon determines if the anticoagulant therapy is stopped several days before surgery, which it often is.
  20. True or False 
    Diabetic patients on insulin are told to increase their normal insulin dose the day of surgery
    • False
    • The patient may be told by the physician to either take no insulin, the normal dose of insulin, or half of the normal dose.
  21. True or False
    Blood glucose monitoring for diabetic patients is ordered on admission
  22. True or False
    If a patient is on chronic oral steroid therapy it cannot be abruptly stopped when nil per os (NPO)
  23. True or False
    Surgery is not a serious stressor for the body.
    • False
    • Surgery is a serious stressor for the body
  24. true or False
    Chronic oral steroid therapy should be continued via the parental route if the patient is NPO
  25. True or False 
    Circulatory collapse can develop if steroids are not stopped abruptly
    • False
    • Circulatory collapse can develop if steroids ARE STOPPED ABRUPTLY
  26. Time Frame- Incision to 2nd postoperative day
    Wound Healing- Inflammatory response 
    Patient Effect- Fever, malaise
    • Phase 1
    • Time Frame, Wound Healing, Patient Effect
  27. Time Frame- 3rd to 14th postop day 
    Wound Healing- Granulation tissue forms
    Patient Effect- Feeling better
    • Phase 2
    • Time frame, Wound healing, Patient effect
  28. Time Frame- 3rd to 6th postop week
    Wound Healing- Collagen deposited 
    Patient Effect- Raised scar formed
    Phase 3
  29. Time Frame- Months to 1 year 
    Wound Healing- Wound contracts & shrinks 
    Patient Effect- Flat, thin scar
    • Phase 4 IV
    • Time Frame, Wound healing, Patient effect
  30. Its for nursing interview, diagnostic testing, anesthesia interview, & preoperative teaching to ensure patient is in the best possible condition for surgery
    Pre-admission testing
  31. Laboratory tests:blood glucose, creatinine, blood urea nitrogen (BUN), electrolytes, complete blood count, prothombin time, partial thrombosplastin time, bleeding time, type & screen & urinalysis are some common test; oxygen saturation, electrocardiogram, chest x-ray
    what pre admission testing may be done:
  32. What are the 2 primary responsibilities of the perianesthesia care nurse?
    Maintaing the patient's airway and safety
  33. What does deep breathing & coughing prevent?
    Atelectasis & pneumonia
  34. Leg exercises & activity prevent?
  35. Drains are inserted to prevent____?
    Fluid accumulation & infection
  36. When the patient's signature is witnessed by the nurse on the surgical consent, what does that mean?
    The nurse verified that the patient signed the consent.
  37. What is an intraoperative outcome for a patient undergoing an inguinal hernia repair?
    Maintains skin integrity
  38. What kind of goals:
    -Verbalizes goals
    -Demonstrates leg exercises
    -Explains deep breathing exercises
    Preoperative goals
  39. Discharge criterion from the PACU for a patient following surgery?
    Oxygen saturation above 90%
  40. Discharge criteria from ambulatory surgery for patients following surgery?
    Understands discharge instructions
  41. Long term steroid therapy cannot be abruptly stopped because?
    Higher steroid levels are needed during stress.
  42. Complications that a nurse would correctly explain to a patient can be prevented with early postoperative ambulation
    Pneumonia can be prevented with lung expansion promoted by ambulation
  43. The nurse is caring for a patient with a bowel resection. What would indicate that the patient's gastrointestinal tract is resuming normal function
    • Presence of flatus 
    • It occurs with normal bowel functions
  44. Bowel is not functioning when:
    Firm abdomen & absent bowel sounds
  45. After surgery, patient's urine is dark amber & concentrated? Why?
    The sympathetic nervous system saves fluid in response to stress of surgery
  46. The patient develops a low-grade fever 18 hours post-operarively & has diminished breath sounds. What should the nurse do to prevent complications?
    • Encourage coughing & deep breathing
    • -Ambulate patient as ordered
  47. May be elective, urgent or emergency
    Purpose: To preserve life, repair or remove body part
  48. -Primarily elective
    Purpose: To restore function, remove skin lesion & to correct deformities
  49. May be major or minor. Make or confirm diagnosis
    Ex: breast diagnosis
  50. Usually major. Diseased body part removed.
    Ex: Appendectomy, Amputation
  51. To restore function to traumatized or malfunctioning tissue
    Ex: Scar revision, plastic surgery
  52. To replace organs or structures that are diseased 
    Ex: heart, kidney, liver & cornea
  53. Influencing factors of surgery
    • Age: old & young don't tolerate surgical procedures 
    • Physical condition: Pt's with chronic disease or health problems require longer recovery periods.
    • Nutritional factors:
  54. Vitamin B (Thiamine) is for
    GI tract
  55. Vitamin C is for
    wound healing
  56. Vitamin K is for
  57. Blocks central awareness centers in brains, Administered by IV, inhalation
    -Loss of consciousness, sensation, skeletal muscle relax & reduction of reflex
  58. Minimal, can move
    Conscious cidation
  59. Surface/ topical applied directly to skin & mucous membranes
  60. Used in minor procedures like skin biopsy / suturing
  61. Anesthesia in nerve trunk
    Nerve block
  62. Via lumbar puncture into subarachnoid space
  63. -Protects the client, physician & the health care institution, legal document
    -Description of the procedure /Treatment
    -Name & qualification of person performing procedure 
    -Explanation of risks involved
    -Explains alternatives/ possible effects of not having treatment
    -Info. that patient has the right to refuse treatment
    Informed consent
  64. Consent forms are not legal if:
    • client is considered a minor, confused, unconscious, sedated, mentally incompetent 
    • -consent in these instances may be given by parent/guardian
  65. Height, weight, VS, general appearance, provides base line data
    -status of skin
    -Respiration status
    *Cardiovascular status 
    *Immunologic status:history of allergies, immunosuppression common with radiation & chemo therapy
    *Abd status: Bowel sounds, size, shape, last BM
    *Endocrine status: in uncontrolled diabetes, hazard in hypoglycemia from anesthesia 
    *Neurologic status: Mood, motor & sensory function, follows all commands
    Pre-operative Physical Assessment
  66. The edges of the wound are approximated with staples or sutures. Minimal scarring.
    -occurs in a clean wound
    1st intention (Primary)
  67. The wound is left open & allowed to heal by inside/out. Scarring is usually big w/ longed healing.
    -Large, irregular or infected wounds
    -Pressure ulcers are or chronic wounds are treated this way.
    2nd intention (Secondary)
  68. An infected wound is left open until there is no evidence of infection & the wound is then surgically closed.
    -Granulation tissue fills in for some wound healing & then edges are approximated
    -Wider scarring occurs
    3rd intention (tertiary)
  69. White blood cells, dead & live bacteria, warm, reddened, & tender and may have drainage (pus).
  70. place the patient in low fowlers position with flexed knees. Cover the wound w/ sterile dressings or towels moistened w/ warm sterile normal saline. -Notify Dr. immediately of surgical emergency. 
    -Apply gentle pressure over the wound
    -Monitor VS for evidence of shock
    -Prepare pt for immediate surgery
    If dehiscence or evisceration occur:
  71. Mostly clear portion of blood, large #s of RBC's
  72. Composed of fluid & cells escaping from blood vessels
  73. Caused by bacterial invasion
  74. WHat kind of asepsis for dressing changes
    Surgical asepsis
  75. Excessive blood loss wither internally or externally
    -May occur from a slipped suture, clot or stress on operative site
    -Assess for restlessness
    Goal: stopping the bleeding, replacing the blood volume 
    -Intervention: Pressure dressing to bleeding
  76. Partial or total disruption of wound layers 
    -Goal: prevention- good nutritional status promotes wound healing, aseptic technique 
    -If superficial, may only need steristrips
  77. Spilling of viscera thru the incision 
    -Goal: good nutrition 
    -Interventions: Cover wound area w/ a saline soaked sterile towel
  78. Provides a sinus tract
    Penrose Drain
  79. For bile drainage after a gall bladder
    T Tube
  80. Decreases dead space by collecting drainage usually after abdominal surgery
    Jackson Pratt
  81. Decreases dead space by collecting drainage usually w/ orthopedic surgery
  82. Purpose: Inspect for healing & sign of infection
    Advantages: absorbs drainage, protect the wound, used as pressure dressing, splint or immobilize the wound
    Supplies: Cleansing agent, Dressing, Tape, / montgomery straps
    Wound dressings
  83. -Cause: Decreased blood flow, decreased circulation to body part, decreased oxygen called ischemia 
    -Risk: bony prominents
    Pressure Ulcer
  84. Redness (Erythema)
    Stage 1
  85. Superficial layer (epidermis/dermis)
    Stage 2
  86. Damage or necrosis of subcutaneous tissue
    Stage 3
  87. Damage to muscle-bone
    Stage 4
  88. Chronic renal disease
  89. For dehisced surgical incisions that resist healing, aids in healing the incision. 
    -Applies negative pressure to wound edges
    Vac (vacuum assisted closure)
  90. Removal by cutting
  91. Suture of or repair
  92. Looking into
  93. Formation of a permanent artificial opening
  94. Incision or cutting into
  95. Formation or repair
  96. Not smoking increases the action of the lungs defense mechanisms & makes more hemogoblin available to carry oxygen during surgery.
  97. Long term alcohol use causes nutritional & liver damage. It can create bleeding problems, fluid volume imbalances & drug metabolism alterations.
  98. Collapse of the lung caused by hypoventilation or mucous obstruction preventing some alveoli from opening & being fully ventilated
  99. Do this hourly while awake, sets of 5, for 24-48 hours postoperatively
    Deep breathing
  100. Prevents atelectasis by increasing lung volume, alveoli expansion & venous return 
    -For elderly & people w/ respiration problems 
    -sit at 45 degrees 
    -Take 2 normal breaths 
    -Inhale until target is reached 
    -hold for 3-5 seconds 
    -exhale completely 
    Perform 10 sets of breaths each hour
    Incentive spirometer
  101. causes the patient to loose sensation, consciousness, & reflexes.
    -Acts directly on the central nervous system
    general Anesthesia
  102. Blocks nerve impulses along the nerve where it is injected, resulting in the loss of sensation to a region of the body w/o the loss of consciousness
    Local anesthesia (regional)
  103. A localized collection of extravasated blood, usually clotted, in an organ, space or tissue