ATI: The Surgical Client

tachypnea, tachycardia; other manifestations may include tinnitus, numbness around the mouth, drowsiness, a metallic taste, numbness, tremors, seizures, or coma

during a local anesthesia procedure, *the nurse's responsibility is to be aware of the manifestations of drug toxicity*. what are some examples of drug toxicity in local anesthetics such as lidocaine and benzocaine?

informed consent

pre-op formal permission granted by the pt or the pt's legal guardian to receive surgery

speak up *the surgical site should be marked by a licensed provider who will be present during the surgical procedure*

to reduce the incidence of surgical errors, The Joint Commission developed a verification process, known as ________________, to ensure that the correct surgical procedure is performed on the correct client and the correct site (e.g., right leg versus left leg)

- must be prompt - early detection/diagnosis 1. Dantrolene sodium (skeletal muscle relaxant) 2-3 mg/kg 2. Stop all inhalant anesthesia agents 3. Intubate, ventilate with 100% O2 with high flow rate 4. Packed in ice/cool compresses to remove body temp

treatment for malignant hyperthermia

adminster diuretics and restict fluids

treatments commonly used to treat hypervalemia

insertion of a nasogastric tube and IV fluids because the client will be NPO

upon auscultation of an ileus, the nurse may note absent or minimal bowel sounds, indicating minimal peristalsis. manifestations of an ileus include nausea, vomiting, and mild discomfort in the abdomen. palpation will reveal a nontender abdomen, except where inflammation is the underlying cause. if the client passes stool, it will be a small amount and have a watery consistency. what are some treatments for an ileus?

a. neurosensory b. repiratory c. integumentary d. cardiovascular

which systems in particular do these post-op interventions help? a. reorientation to place and time b. coughing exercises c. splinting during coughing d. ankle pump exercises

hydration decreases the risk for cardiovascular complications. specifically, fluid intake decreases the likelihood of clot formation and increase blood volume

why is hydration important after surgery?

malignant hyperthermia

a hereditary condition; a severe reaction to certain drugs used during anesthesia that is characterized by uncontrolled heat production & includes a dangerously high body temp, rigid muscles or spasms, a rapid heart rate, and other symptoms; can be life-threatening

malignant hyperthermia

a history of which condition can place a pt at an increased risk for a life-threatening event during surgery and requires prophylactic measures (measures designed to prevent the occurrence of an adverse event) to be in place?

a rationale: minimal peristalsis, nausea, and mild discomfort are an indication that the client may have developed an ileus.

a nurse is caring for a client who is 2 days postoperative following abdominal surgery and reports discomfort and nausea. the nurse notes minimal bowel sounds on auscultation. the nurse should anticipate that the client may have which of the following conditions? a. an ileus b. dehiscence c. IBS d. hemorrhoids

pre-op (admission --> OR) intra-op (OR --> recovery or PACU) post-op

3 stages of the perioperative period

administer IV fluids

low urinary output, also known as oliguria, is common in postoperative clients, but is more prevalent in individuals with chronic kidney conditions. other risk factors for this complication include older age, diabetes, heart failure, HTN, and peripheral vascular disease. to manage the low output, what should the nurse do?

Tachycardia Hypotension Confusion Oliguria (low urine output) Decreased central venous pressure (CVP) Decreased capillary refill

manifestations of hypovolemia may include:

to determine the client's hydration status (the nurse should document the level of moisture and color of the mucous membranes, including the gums. missing or broken teeth should be noted, and the anesthesia provider should be made aware of these findings) also: dentures, piercings, or prosthetics need to be removed. the lymph nodes should be palpated for lumps, nodules, or tenderness, which may indicate infection. the nurse should also assess nasal drainage for yellow or green nasal discharge, which are signs of an infection

pre-op an examination of the head and neck should be performed, including evaluation of the mucous membranes. why are the membranes looked at so closely?

to verify and witness that the client or representative has signed the consent in their presence, is of a legal age, and is competent; the nurse is also responsible for confirming the client has adequate information to make the decision (the provider is responsible for giving the client knowledge about the procedure)

pre-op what is the nurse's role when obtaining informed consent?

c. regional rationale: with regional anesthesia, the client will experience a temporary loss of feeling to an area of the body a. local anesthesia affects the motor and sensory nerves at the surgical site b. general anesthesia is medications or inhalants used to depress the central nervous system.

a client is having surgery on their hand and tells the nurse that they understand that anesthesia will be administered so that they will have a temporary loss of feeling in their arm. which of the following types of anesthesia is the client describing? a. local b. general c. regional d. epidural

dehiscence manifestations of dehiscence that the nurse should monitor for include the presence of an open wound, bleeding, swelling, pain, fever, or redness. treatment may include a prescription for an antibiotic, frequent dressing changes, or keeping the wound open to promote new tissue growth, thereby optimizing wound healing. some clients may require additional surgery

a complete or partial separation of the suture line and underlying tissues that occurs when a wound fails to heal properly; this condition most commonly occurs after abdominal surgery

pulmonary embolism (PE) occurs when a part of the clot causing the DVT breaks off and travels to a blood vessel of the lungs, occluding it; manifestations include chest pain, especially while taking a deep breath; difficulty breathing; tachycardia; and hypoxia

a complication of a DVT; an obstruction of blood flow in a pulmonary artery due to the movement of a blood clot from an extremity to the lungs

evisceration

a complication of dehiscence; the protrusion of internal organs through a surgical wound which has dehisced or opened; this is an emergency and requires immediate attention

deep vein thrombosis (DVT) clients are at risk for DVT following surgery due to prolonged inactivity during and even after surgery. prevention of DVT includes mobilization soon after and frequently after surgery, as well as application of sequential compression devices (SCDs) to the lower extremities while the client is in bed or the chair; manifestations of DVT include pain, redness, and swelling of the affected limb; the area of concern may also be warm to the touch

a condition that results from a blood clot inside a deep vein, usually within the extremities

c rationale: c. chest pain, shortness of breath, tachycardia, and hypoxia is indicative of a pulmonary embolism and is a medical emergency. the nurse should immediately activate the emergency response team and notify the client's provider. a. a client who is experiencing hypovolemic shock following surgery will have major loss of intravascular fluid and will have manifestations of hypotension, confusion, tachycardia, and oliguria. b. a client who is experiencing a deep vein thrombosis will experience pain, redness, and swelling within the lower extremity. d. a client who is experiencing a thrombotic stroke will have neurological deficits such as confusion, impaired speech or understanding, dizziness, or numbness or weakness on one side of the body.

a nurse is caring for a client who is postoperative following a femur fracture repair. the client suddenly reports chest pain and is experiencing shortness of breath. which of the following conditions should the nurse suspect? a. hypovolemic shock b. deep vein thrombosis c. pulmonary embolism d. thrombotic shock

a, b, d rationale: d. the nurse should document the client's spiritual beliefs to provide empathy and emotional support to the client. c. only document CURRENT meds

a nurse is collecting data from a client who is preoperative for a surgical procedure. which of the following information should the nurse document in the client's medical record? SATA a. allergies b. alcohol use c. discontinued meds d. spiritual beliefs e. financial status

a, b, d, & f rationale: b. corticosteroid therapy slows wound healing c. a BMI of 30 or higher is at greater risk

a nurse is reviewing the medical record of a postoperative client. which of the following findings in the client's history are risk factors for poor wound healing? SATA a. diabetes mellitus b. corticosteroid use c. BMI 28 d. current smoker e. married f. 68 yrs old

to establish a baseline so that providers can determine whether any changes develop at any time during the perioperative period *changes in mental status can be the first indication that the client's medical status may be declining* motor functioning should also be assessed to establish a baseline and identify any weaknesses or impairments

pre-op why is a neurologic assessment done prior to surgery?

example meds: diazepam, lorazepam, and midazolam procedures: dental procedures, removal of cataracts, colonoscopy, and wound repair

a. meds used in moderate sedation b. procedures done under moderate sedation

68-75 F

a. surgical environment keeps the room at this temp to decrease the growth of pathogens bacterial growth and static electricity are also controlled by keeping the relative humidity between 20% and 60%

a. genetic mutation of ryanodine receptor 1 (remember: rihanna receptor) b. exposure to volatile anesthetics (such as halothene) or depolarizing muscle relaxants (such as succinylcholine) c. dantrolene

a. what is malignant hyperthermia caused by? b. what is it triggered by? b. what medication is it treated by?

regional anesthesia

anesthesia applied to a limb or an entire section of the body that causes a loss of sensation in that area; impairs sensory neurons

aseptic technique

procedure performed under sterile conditions; a method used to avoid contamination through the transfer of microorganisms from the staff/equipment to the patient during surgery

Certified Surgical Technologist (CST) aka scrub tech the CST confirms by counting the sponges, instruments, and sharps used in the surgery, and their removal from the client at the end of the procedure. once this check is completed, the nurse documents this information in the client's electronic medical record

another task of the circulating nurse is to maintain sterility, while providing supplies and equipment to the sterile team. this nurse, along with the ____________________________________, ensures the utensils used during surgery are sterile and ready for use. the __________________________________ primary role is ensuring the instruments used during the surgery are sterile and ready for use ("THE SURGEON'S HANDS" hands the equipment or tools needed to the surgeon during surgery, transfers the client in and out of the surgical suite, applies suction, assists with suturing, and documents during the procedure, etc.)

1. PACU 2. PRE-OP 3. OR

based on the nursing actions, determine the appropriate nurse to perform it (choices: PACU, OR, PRE-OP) 1. manage nausea, control shivering, administer pain meds 2. perform teaching on deep breathing, collect pt's height & weight, witness consent 3. initiate time-out procedure, ensure patent airway, provide updates to the family, obtain supplies for the surgery team

AORN (Association of Operating Room Nurses) or peri-op nurses

professional org that promotes safety for clients undergoing surgery or other invasive procedures by creating guidelines to advance and support operating room nurses

deep vein thrombosis (DVT) & pulmonary embolism (PE)

clients undergoing surgery, especially long and complex surgeries, are at risk for venous thromboembolism (VTE). there are two types of VTE, what are they?

circulating nurse

coordinates the care of the client before, during, and after the surgical procedure.

an IV anticoagulant

if a PE (pulmonary embolism) is suspected, the client may be started on what typically?

ileus *more prevalent after abdominal surgery, especially after the intestines have been manipulated*

loss of peristalsis with resulting obstruction of the intestines; a post-op complication that develops due to a temporary, short-term disturbance in the peristaltic movement of the intestines

surgical site infections (SSIs) to monitor for SSIs, nurses should assess the surgical site for signs of infections such as redness, swelling, pain, and purulent or foul-smelling drainage treatment for SSIs includes diagnostic testing— wound cultures to identify the bacteria and serum levels to assess for infection. other therapies include antibiotics, possibly wound debridement (removal of the infected or dead tissue), and dressing changes

often caused by Staphylococcus, Streptococcus, and Pseudomonas bacteria. the surgical site may become contaminated by the practitioners' hands or surgical instruments, organisms that travel through the air, or organisms that are already present on the skin or in the body

Tachycardia Increased CVP Hypertension Crackles in the lungs Peripheral edema Decreased hemoglobin and hematocrit

peri-op hypervolemia can occur during the perioperative period for several reasons. these reasons include a history of chronic conditions that cause fluid retention, such as CHF or renal insufficiency or failure. hypervolemia can also occur due to rapid loss of fluids or blood, such as in trauma. This imbalance can cause a number of complications in the perioperative pt, including impaired gas exchange, decreased bowel motility, and impairment of wound healing. manifestations of hypervolemia may include:

a. pre-op hypovalemia 1. lack of fluid intake due to NPO status 2. administration of bowel prep for abdominal surgery 3. physiological condition or injury that causes intravascular fluid loss b. intra-op hypovalemia 1. anesthesia-related medications that may cause widespread vasodilation and impaired myocardial function 2. loss of blood due to hemorrhage or coagulopathies 3. prolonged surgical time, especially open abdominal surgeries *interventions to prevent hypovolemia include close hemodynamic monitoring throughout the peri-op period. if this complication does occur, it is treated with fluid replacement with crystalloids, colloids, blood, or blood products, depending on the reason for fluid loss*

peri-op hypovolemia can occur during the perioperative period for several reasons. many of these reasons reflect factors such as the urgency of surgery (emergency versus elective), the type of surgery, and the length and complexity of surgery. a. PRE-OP hypovolemia can be caused by what 3 things? b. INTRA-OP hypovolemia can be caused by what 3 things?

anticoagulants (low-molecular-weight heparin [LMWH] or warfarin)

peri-op/post-op obesity also places perioperative clients at increased risk for developing a deep vein thrombosis or pulmonary embolism. therefore, prophylactic administration of what type of medication is often prescribed for the postoperative client?

Alzheimer's disease History of stroke Parkinson's disease

post-op 3 conditions that increase a client's risk for developing POCD (postoperative cognitive dysfunction)

atelectasis clients with a history of smoking or chronic lung conditions such as COPD have a higher risk of atelectasis postoperatively

post-op a common postoperative complication that occurs due to decreased function of surfactant in the lungs, a condition caused by anesthesia. the decreased surfactant activity leads to the collapse of the alveoli in the lung, which can then cause partial or full collapse of the lung, pneumonia, or respiratory failure

straight cath straight catherization is similar to inserting a urinary catheter, but the catheter is removed once the bladder has been emptied of urine

post-op a pt had surgery early in the morning and is now experiencing a distended bladder and has not voided in the past 6-8 hrs. what is the best nursing action?

postoperative cognitive dysfunction (POCD) (research still needs to be done on strategies to prevent this postoperative complication)

post-op a serious condition for which both older adults and clients with preexisting neurocognitive disorders are at risk for when undergoing anesthesia; causes permanent long-term memory loss, and clients can experience changes in their behavior and neurocognition that last for weeks or even months

anticholinergics used to decrease secretions in the upper airway

post-op after surgery, clients may experience confusion for a brief period. as noted earlier, older adult clients, particularly those with dementia, are at greater risk for developing postop delirium. the risk for confusion and post-op delirium is even greater after the administration of what meds?

a decrease in BP, tachypnea, and possibly a decrease in oxygen saturation nursing interventions during this post-op stage include closely monitoring the client's vital signs and noting any changes in the client's mental status

post-op bleeding is a major concern for clients after surgery. what are some indications that a client may be bleeding?

positioning, early ambulation, ankle pump exercises, SCD use, and antiembolism stockings—should be implemented as soon as possible

post-op careful attention should be given to the assessment of the extremities, including pulses and any signs and symptoms that may indicate the presence of a DVT. interventions to prevent complications include....

postoperative delirium prevention of post-op delirium includes not only risk factor identification, but also effective pre-op pain management, while avoiding the use of benzodiazepines as well as opioid-based pain meds; *identification of risk factors prior to surgery is key to prevention*

post-op confusion and disorientation occuring after surgery in the older adult client; it's temporary and may come and go days to weeks after surgery

pt's airway, breathing, circulation, ventilation, vital signs, oxygen sat, and level of consciousness pt requires frequent assessment. the goal is to ensure proper healing and prevent potential complications. upon receiving the pt from the operating suite, the nurse should complete a physical assessment as soon as possible

post-op following the completion of the surgical procedure, the immediate postoperative phase begins. in reference to the pt, what are a few of the priorities at this time?

the primary surgeon assistant surgeon anesthesiologist/certified nurse anesthetist (CRNA) circulating nurse surgical assistants a scrub technician/nurse who works around a sterile field

responsibilities during the surgical procedure are assigned to the perioperative team, which consists of what 6 individuals?

used for deep breathing; use of this device is recommended postop to reestablish lung functioning; it decreases the risk of atelectasis by mobilizing secretions from the lungs pt teaching: ten repetitions per hour should be done with the IS, and each breath held for 3 to 5 seconds. coughing and deep breathing are also used to clear the airway and are recommended every 2 hours for the postsurgical client note: early ambulation also promotes deep breathing, expands the chest wall, clears the airway, and decreases the risk of complications such as atelectasis, pneumonia, and DVT

post-op following the immediate postoperative stage (checking for airway, consciousness, baseline, etc.), the client should be encouraged to engage in incentive spirometry, coughing, and early ambulation as soon as possible. why is the use of an incentive spirometer (IS) so important following surgery? how should the nurse tell the pt to use it?

24-48 hrs if signs of infection become apparent (as indicated by a pain, redness, or drainage), the dressing will be removed. the site should be checked frequently. a drain tube may be placed during surgery and monitored for the drainage collected. *when the client has skin staples, sutures, or other closures, they may be left in place for 7 days or longer*

post-op for surgical wound care, a sterile dressing may be applied in the surgical suite to cover the wound, if needed. this dressing will be left in place generally how long, at the discretion of the surgeon?

- pts should eat in a chair or sit up during meals or when drinking and should remain upright for at least ONE hour after doing so - food should be cut into small pieces and chewed completely before swallowing - the nurse should advise the client to drink and eat slowly - the client should be instructed to avoid watching television or talking while eating

post-op four important nurse teachings to decrease the risk of pt aspiration post-op

pt's airway and breathing

post-op immediately following surgery, what is the #1 biggest concern?

the Comprehensive Geriatric Assessment (CGA)

post-op in older adults, this assessment is helpful in identifying the risk factors for malignant hyperthermia

a prescription for an antiemetic

post-op nausea and vomiting are common problems for clients during postop bc of general anesthesia, a history of motion sickness, or abdominal surgical procedures, or as an adverse drug effect from opiate analgesics. manifestations will typically develop in the postoperative care unit and may last up to 24 hours. as a result of vomiting, the client is at risk for dehydration and electrolyte imbalances. to counteract these risks, the pt is given what?

a patient-controlled analgesia (PCA) pump

post-op pain mgmt postop is extremely important. opioid-based pain medications are generally used immediately postoperatively. when needed, the provider may prescribe this, which gives the client the ability to self-administer medication as needed to control their pain

recent brain or eye surgery; due to intracranial pressure

post-op pts who have undergone what types of surgeries should use caution when performing coughing exercises postop to help clear the airway?

1. early ambulation is recommended postop to promote a return of normal GI function 2. the provider may prescribe a laxative to help peristaltic movement of the bowels if the client has not had GI surgery. stool softeners such as docusate may also be prescribed to help with constipation.

post-op the nurse should always auscultate the client's abdomen for active bowel sounds and inquire if the client is experiencing any nausea or vomiting postop. due to the adverse effects of anesthesia and bowel surgery, the client may have limited gastric motility after surgery. what things can the nurse suggest to increase and promote GI function?

1. closely monitor ox sat 2. place all non-essential meds on hold 3. mobilize the pt when possible 4. monitor fluids and electrolyte status

post-op the nurse should do what 4 things when a pt is suffering from post-op delirium?

the mucous membranes of the oral cavity and eyes for pallor and dryness; the nurse should examine the client's skin for evidence of tenting, a possible indicator of dehydration

post-op the nurse should monitor the pt's renal sysem and urine output following surgery. the nurse should document the client's hydration status by monitoring and recording all oral, IV, and enteral intake and all output, including urine, vomitus, and surgical drainage, postop. hydration is also assessed by examining what on the pt?

the nurse should instruct the client to hold a pillow over the incision (known as splinting) when coughing - this reduces pain and supports both the incision and tissue surrounding the area

post-op the pt should be repositioned every hour while awake or as the nurse directs. repositioning is done to prevent muscle weakening, blood clots, and lung infection. splinting is advised for pt's who have an incision in the chest or abdominal area, as such a wound can create pain during coughing or moving. what is splinting and how does it help?

postoperative delirium and postoperative cognitive dysfunction

post-op two most common postoperative complications in older adults

a patient-controlled analgesia (PCA) pump a computerized pump with a syringe of pain medication connected to an IV line that allowed the pt to self-administer pain meds. the pump can administer meds either in a small constant flow or PRN. with the press of a button, the client can self-administer pain medication based on the current level of pain.

post-op what is a PCA?

decreases clot formation due to immobility and increases blood volume lost from bleeding after surgery hydration is vital to decrease the risk of cardiovascular complications. fluid intake decreases the likelihood of clot formation and increases the blood volume. clots form when the blood cells are concentrated and gather in the blood vessels.

post-op why is it important for a pt to stay hydrated?

c. infection rationale: ongoing tobacco use makes it difficult for the anesthesiologist to regulate the client's breathing while the client is under and causes the heart to work harder due to harm within the heart and blood vessels. in addition, tobacco use can lead to slower wound healing. finally, bc oxygen is the main source of healing, the client's risk for developing infections is greater when the client has engaged in recent use of tobacco

pre-op a nurse is interviewing a client during the preoperative phase. the client reports smoking 6 to 7 cigarettes per day for the past 4 years. the nurse should identify that tobacco use prior to surgery can increase the client's risk for which of the following complications? a. bleeding b. nausea c. infection d. hypothermia

1. general information: info about the day of surgery (such as what time to arrive, where to check in, what to bring, the policy for visitors, and how long the pt can expect to stay) 2. preparation for surgery: - NPO status - skin preparation (the client may need to wash with a special soap at home prior to surgery) - medication (client may be asked to stop taking certain medications and supplements prior to surgery) - tobacco and alcohol cessation (clients should be educated about the benefits of tobacco and alcohol cessation prior to surgery) 3. postoperative expectations: - what to expect immediately following surgery - how pain will be rated and controlled immediately postoperatively and once at home - the importance of coughing and deep breathing after surgery. this should include techniques for incision splinting and how to use an incentive spirometer - activity following surgery, including the importance of early mobility as well as any restrictions the client may have following surgery

pre-op depending on the situation, preoperative teaching may begin weeks to days prior to surgery, or it may need to be done immediately prior to surgery. THREE topics that may be included in preoperative teaching include the following:

AORN's Comprehensive Surgical Checklis

pre-op during the entire perioperative process, communication is essential. a lack of effective communication can lead to errors and client harm. the Joint Commission and AORN have created standardized tools to ensure effective communication throughout the perioperative process. one way for members of the perioperative team to communicate is via ________________________________________________, which helps ensure that communication continues across the continuum of the perioperative phase

chronic obstructive pulmonary disease (COPD) obstructive sleep apnea (OSA) asthma coronary artery disease (CAD) congestive heart failure (CHF) the nurse should report any preexisting conditions or other concerns

pre-op during the health history, the nurse should assess the client for current or previous health conditions that may present a risk for surgery. this includes assessing the client for a history of *cardiovascular and pulmonary diseases*. which 5 conditions are most likely to cause the most intraoperative complications?

AORN's Comprehensive Surgical Checklis

pre-op helps ensure that communication continues across the continuum of the perioperative phase

a complete blood count (CBC) the CBC can provide information on the client's fluid status and indicate whether the client is anemic or has an infection additional laboratory tests may be done to determine the client's kidney and liver function (comprehensive metabolic panel [CMP] or basic metabolic panel [BMP]) as well as electrolyte levels. a fasting blood glucose level or hemoglobin (HbA1c) level may be prescribed if the client is diabetic

pre-op most common laboratory test done preoperatively

difficulty intubating the client (i.e., placing a breathing tube) decreased oxygenation increased time for the body to process anesthesia medications respiratory complications when given narcotic pain meds or other meds that may cause sedation

pre-op obesity alone can increase the risk of complications of surgery. these most common potential complications include which 4 things?

multimodal therapy this uses several types of pain medication to reduce pain in different ways; this will limit the side effects of high-dose pain meds (e.g., nausea, constipation, and sedation) while enabling the client to benefit from pain relief obtained through nonpharmacological methods (e.g., relaxation techniques, massage)

pre-op perioperative pain control utilizes what type of approach when medicating pain while also limiting the use of opioids?

1. blood clots 2. myocardial infarction 3. death tobacco use can also lead to slower wound healing, higher risk for infections, etc. *regular alcohol use can also place clients at a higher risk for complications such as bleeding, infections, heart problems, and a longer hospital stay*

pre-op prior to surgery, the nurse should collect the client's history of tobacco and alcohol use. recent tobacco use can place the client at an increased risk for complications during and or after surgery. name 3 complications associated w/ tobacco use and surgery:

inspection, auscultation, palpation, and percussion note: *prior to the abdominal assessment, the client should empty their bladder to allow for accurate inspection of abdominal contour, symmetry, and distention*. bowel sounds should be auscultated in all four quadrants and the nurse should ask the client about the regularity of bowel habits. difficulty swallowing, nausea, vomiting, and any other GI manifestations that the client is currently having should be documented preoperatively

pre-op the nurse must perform the four assessment techniques in the proper order when assessing the abdomen; this is a different order than that used for the other systems' assessment. for the gastrointestinal (GI) system, the proper order of assessment techniques is ........

malignant hyperthermia *malignant hyperthermia can develop due to a severe reaction to certain medications given during anesthesia; although this condition can be life-threatening, prophylactic measures can be taken to reduce the risks if the client has a positive history*

pre-op the nurse should collect data about the client's previous surgeries and their response to anesthesia during the surgical history assessment. the nurse should complications experienced with any previous surgical procedures. it is vital that the nurse ask the pt if they or any family members have a history of which life-threatening condition related to anesthesia?

client's medical and surgical history allergies current medications social history *this assessment can identify comorbidities prior to surgery* *if any allergies are present, put an allergy wristband on the pt*

pre-op the pre-op health history portion should generally include what 4 things?

1. preoperative assessment (health history/medical history, head-to-toe assessment, any lab tests, etc. needed prior to surgery) 2. pt education (ensure the pt is well educated on the procedure and has no questions) 3. ensuring informed consent has been obtained *the preoperative assessment has a high priority, and seeks to ensure client safety by identifying any risk factors for surgery and collecting the client's baseline data*

pre-op the pre-op phase begins when the client decides to undergo surgery and ends when the client is transferred to the surgical suite. the nurse has several responsibilities during this phase. what are the main 3?

moderate sedation example meds: diazepam, lorazepam, and midazolam the client does not need any breathing support during moderate sedation; the medication can be administered through an IV injection, inhaled, injected, or orally

sometimes referred to as moderate conscious sedation; permits the client to be comfortable, drowsy but pain free. the client is easy to arouse and able to answer questions and follow simple requests to move or change positions.

at the time the client is moved into the operating room and ends when the client enters the recovery room or the PACU

the intraoperative phase begins and ends when?

ex: lidocaine, benzocaine medication administered to prevent the conduction of pain impulses and allows the client to remain awake and alert examples of procedures in which local anesthetic is used: repair of a broken bone, breast biopsy, and suturing a deep cut

there are three types of anesthesia are used: local, regional, and general. anesthesia can result in a limited or total loss of feeling to an area and can occur with or without loss of consciousness. what is local anesthesia and what are some instances it may be used?

causes a temporary loss of feeling in a localized area of the body the anesthetic is injected near a cluster of nerves in the area requiring surgery and the client may be awake or sedated example procedures: surgeries done on the legs, abdomen, or extremities examples of regional anesthetics are spinal and epidural blocks, which may be given during childbirth

there are three types of anesthesia are used: local, regional, and general. anesthesia can result in a limited or total loss of feeling to an area and can occur with or without loss of consciousness. what is regional anesthesia and what are some instances it may be used?

aspiration this can lead to problems breathing or pneumonia—and *it is why fasting before surgery is advised*

this develops when food or liquids are breathed into the airway instead of entering the esophagus *during surgery, clients are at risk for this due to stomach contents moving up to the mouth and into the trachea or lungs*

Certified Surgical Technologist (CST) aka scrub tech

this individual has obtained certification by the National Board of Surgical Technology and Surgical Assisting (NBSTSA); responsible for ensuring the instruments used during the surgery are sterile and ready for use; this person's hands are the equipment or tools needed for the surgeon during surgery

aldrete score

this is calculated to assess a client's postanesthesia status

a time-out *normally the circulating nurse is in charge of calling the time-outs*

this is performed at regular intervals during a surgical procedure—before the start of the procedure, before starting an additional procedure as applicable, and at the completion of the surgery—by a designated team member (normally the circulating nurse), to ensure that all questions or issues have been clarified by the surgical team. *the team members must agree that the identity of the client, the surgical site, and the surgical procedure are correct before they proceed.* all time-outs are to be documented upon their conclusion

intra-op

this phase begins in the surgical unit and ends in the recovery room or PACU

post-op

this phase, which begins immiedately after surgery, includes rehabiltation and recuperation

involves the use of medications or inhalants to depress the central nervous system pts under general anesthesia are not arousable when a painful stimulus is applied additionally, the cardiovascular and respiratory systems are inhibited, requiring constant monitoring and support of the client's heart function and respiration

what is general anesthesia?

1. it may be necessary for the circulating nurse to remove hair from the surgical site 2. cleanse the surgical site with an antiseptic (iodine, chlorhexidine, or alcohol solution) and allow for drying time 3. preparation begins with scrubbing the surgical site in a circular fashion, starting at the center and moving outward to the area away from the site 4. at the outer edge, the sponge is considered contaminated and must be discarded 5. a new sponge should be used each time the area is scrubbed

what is the proper way for the circulating nurse to clean the surgical site?

patients with: problems swallowing dental problems pyrosis (heartburn) cancer of the esophagus neurologic conditions such as Parkinson's disease or swallowing impairments resulting from strokes are other risk factors

what pts are at higher risk for aspiration?

various times depending but generally - before the start of the procedure (usually after the circulating nurse finishes skin prep on the pt), before starting any additional procedures, and at the completion of the surgery

when are time-outs called?