N2_U1_Surgical Patient

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N2_U1_Surgical Patient
2011-09-11 15:16:58

N2_U1_Surgical Patient
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  1. Define perioperative nursing care.
    Nursing care preoperative, intraoperative and postoperative.
  2. Describe the reasons for which surgery is preformed.
    • Diagnostic
    • Curative
    • Pallative
    • Preventative
    • Explorative
    • Cosmetic Improvement
  3. Determine how surgical procedures are classified.
    • Elective
    • Emergent
    • Urgent
  4. List factors to include in the assessment of the surgical patient.
    • Psychosocial
    • Past Health Hx
    • Medications
    • Allergies
    • ROS
    • Physical Exam
    • Labs
    • Dx Testing
  5. Describe how to correctly witness a patient's informed consent for surgery.
    • Does the pt u/s all the information presented?
    • Was all information disclosed to the pt?
    • Are they signing voluntarily?
  6. Explain the preoperative check list.
    It ensures all pre-op preparations have been completes before and sedating meds are given.
  7. Identify the routine screening tests for surgical patients and identify what the results tell us about the preoperative patient.
    • Urinalysis: renal status, hydration, UTI and disease
    • CXR: pulmonary disorders, cardiomegaly
    • RBC,Hb,Hct,WBC,WBC c dif: anemia, infection, immune status
    • Electrolytes: metabolic status, renal fx, diuretic side effects
    • ABG's & Oximetry: pulmonary and metabolic fx
    • PT,PTT,INR & Platelets: bleeding tendencies
    • Blood Glucose: metabolic status, DM
    • BUN & Creat: kidney fx
    • Serum Albumin: nutrition
    • EKG: heart disease and electrolyte abn
    • LFT's: liver fx
    • Type & Cross: blood availability
    • Hcg: pregnancy
  8. Describe factors that place the older adult at risk for surgery.
    • Increase anxiety
    • Decreased organ fx
    • Increase in other illnesses
    • Increase stress
    • Increase risk of complications
  9. Identify the effects of medications taken preoperatively: Antiarrhythmics, antihypertensives, corticosteroids, anticoagulants, antiseizure, gloucoma and antidiabetic medications.
  10. Identify the content of preoperative teaching as it relates to a pt's postoperative recovery.
    • Instruct pt on deep breathing, coughing and moving
    • Tell pt abt any equiptment, tubes and drains
    • Incentive spirometry
    • PCA
    • Sx specific info
    • Where they will wake up
  11. Define and contrast the types on anesthesia (including conscious sedation) as to their effect on the pt.
    • General: loss of sensation with loss of consciousness
    • Local: lossof sensation without loss of consciousness
    • Regional: loss of sensations to a region without loss of consciousness, also when a specific nerve is blocked with a local anesthetic
  12. Examine the nurses role in the OR.
    • Circulating/Nonsterile Activities:
    • -Reviews anatomy, physiology and the sx procedure
    • -Assists with preparing the room
    • -Practices aseptic technique in all required activities
    • -Monitors practices of aseptic technique in self and others
    • -Ensures that needed itsms are available and sterile if required
    • -Checks mechanical and electrical equiptment and environmental factors
    • -Identifies and admits the pt to the OR suite
    • -Assesses the pt's emotional and physical status
    • -Plans and coordinates the intraoperative nursing care
    • -Checks the chart and relates pertinent data
    • -Admits the pt tp the operating room suite
    • -Assists with transferring the pt to the OR bed
    • -Ensures pt safety in transferring and positioning the pt
    • -Participates in the insertion and application of monitoring devices
    • -Assists with the induction of anesthesia
    • -Monitors the draping procedure
    • - Documents the intraoperative care
    • -Records, labels and sends to proper locations tissue specimens and cultures
    • -Measures blood and fluid loss
    • -Records the amt of drug used during local anesthesia
    • -Coordinates all activities in the room with team members and other health related personnel and departments
    • -Counts sponges, needles and instruments
    • -Accompanies the pt to PACU
    • -Reports information relevent to the care of the pt to the PACU RN

    • Scrubbed/Sterile Activities:
    • -Reviews anatomy, physiology and the sx procedure
    • -Assists with preparation of the room
    • -Scrubs, gowns and gloves self and other members of the sx team
    • -Prepares the instrument table and organizes sterile equipment for functional use
    • -Assists with the draping procedure
    • -Passes instruments to the surgeon and assists by anticipating their needs
    • -Counts sponges, needles and instruments
    • -Monitors practices of aseptic technique in self and others
    • -Keeps track of irrigation solutions used for calculation of blood loss
    • -Reports amount of local anesthesia and epinephrine solutions used by ACP and/or surgeon
  13. Describe the principles of basic aseptic technique in the OR.
    • All materials that enter the sterile field must be sterile
    • if a sterile item comes in contact with an insterile item its contaminated
    • contaminated items should be removed
    • sterile team members must wear only sterile gowns & gloves
    • once dressed only the front of the gown from the chest to the table and the sleeves up to 2" from the elbow are sterile
    • tables are only sterile at table top level
    • package ends are unsterile once the package is open
    • bacteria travel through capillary action such as moist fabric
    • bacteria harbor on pt's and team members hair, skin and respiratory tracts and must be confined with appropriate attire
  14. Describe malignant hyperthermia and identify treatment modalities.
    • Rare metabolic disorder where pt's have hyperthermia and rigid skeletal muscles that could cause death.
    • Definitive tx is prompt administratio of Dantrium, it slows metabolism, along with symptomatic support to correct hemodynamic instability, acidosis, hypoxemia and elevated temp
  15. Identify criteria used to evaluate the pt's readiness for d/c from the PACU.
    • awake
    • stable VS
    • no excess bleeding or drainage
    • no respiratory depression
    • 02 sat above 90%
    • report given
  16. Describe the care of the pt in the immediate PO period on admission to the clinical unit.
    • Monitor and manage respiratory and circulatory fx, pain, temp and sx site
    • Goal is to ientify actual or potential problems that may arise as a result of the sx or anesthesia and intervene appropriately
    • AIRWAY: for patency, oral or nasal airway and trach tube
    • BREATHING: RR & quality, ascultate breath sounds, pulse ox and supplemental O2
    • CIRCULATION: EKG monitor, BP, emp & skin color and peripheral pulses
    • NEUROLOGICAL: LOC, orientation and sensory motor status
    • SX SITE: dressing, drainage
    • PAIN: incisional or other
  17. Identify tasks that can be delegated to assistive nursing personnel.
  18. Describe the use of ESI analgesia and PCA for PO pain management.
    Goal is to provide immediate pain relief and maintain a steady blood level that allows for early ambulation, improved wound healing and earlier d/c
  19. Identify PO complications and the assessments and interventions to correct them.
    • Airway obstruction
    • Hypoxia
    • Hypoventilation
  20. Review the care of a pt undersoing cataract sx.
  21. For individuals s/p sx, what symptoms or situations would require the RN's immediate attn? (Prioritization)