Perioperative Nursing- Exam #2

Liquid Conversions

1 gr (grain)= 65 mg 1 Tbsp =15 mL = 3 tsp *2 Tbsp =30 mL =1 fl oz* *1 cup =250 mL =8 fl oz = 1 glass* *1 pint =500 mL =16 fl oz=1 pound* 1 quart =1000 mL =32 fl oz

Dosage by weight

1. Weight in lb /2.2=wt in kg 2. Total daily dose /#doses per day=amount per dose 3. Desired/ have x quantity =amount per dose

Mass conversion

16 oz= 1 lb 1 kg= 2.2 lbs 1 gm(gram) = 1000 mg 1 mg= 1000 mcg

Incentive spirometry

A common postoperative breathing therapy uses a specially designed spirometer to encourage the patient to inhale & hold an inspiratory volume to exercise the lungs & prevent pulmonary complications

Circulating nurse

A nurse who assists the surgeon & scrub nurse by providing needed materials during the procedure & by handling the surgical specimen. This person does not wear sterile clothing & may enter & leave the operating room during the procedure.

Moderate (Conscious) sedation

Administration of moderate sedation or analgesia, which results in a drug-induced depression of consciousness.

Postoperative Nursing Assessment

Airway & respiration, Circulation, Temperature control, Metabolism, Neurological Function, Fluid & Electrolyte Balance, Skin Integrity & Wound Condition, Metabolism, GI/GU, Mobility, & Comfort/Sleep

Medical Conditions that Increase Risks of Surgery

Bleeding disorders, Diabetes Mellitus, Heart Disease, Hypertension, Obstructive Sleep Apnea (OSA), Upper respiratory infection, Renal disease, Liver disease, Fever/Pyrexia, Chronic respiratory disease, Immunological disorders, Abuse of alcohol/opioids, Chronic pain

Dosage calculations

D ( Desired Dose) HINT: What the doctors orders H (Dose on Hand) HINT: What is available or you are given V (Volume) HINT: Always in mL D / H : V= Amount to Give (answer in mL) HINT: D and H have to have same unit ( If D= 20mcg and H= 0.25mg, Convert H to mcg H= 250mcg)

Dosage calculations: Calculating IV infusion rate

Ex: nurse is preparing to administer dextrose 5% in water 500 mL IV to infuse over 4 hours. The nurse should set the IV infusion pump to deliver how many mL/hr> -Volume (mL)/Time (hr) = X -500 mL/4 hr = 125 mL/hr

Preparation on the Day of Surgery

Hygiene, Preparation of hair and removal of cosmetics, Removal of prostheses, Safeguarding valuables, Preparing the bowel and bladder, Vital signs, Prevention of DVT- Anti Embolism devices, Administering preoperative medications, Documentation & hand-off, Eliminating wrong site & wrong procedure surgery

Preoperative teaching plan

Instruction regarding a patient's anticipated surgery & recovery that is given before surgery. Instruction includes, but is not limited to, dietary & activity restrictions, anticipated assessment activities, postoperative procedures, & pain-relief measures.

Pressure Injury Prevention

Intrinsic Risks- patients tolerance to a pressure injury insult; Extrinsic Risks- variables that increase to a pressure injury result; OR Risk Factors- length of surgery, position on the OR table, positioning device used, warming devices, anesthetic agents, intraoperative hemodynamics, & length of time on the OR bed

Acute care: postoperative

Maintaining respiratory function, Preventing circulatory complications, promoting early mobility, achieving rest & comfort, temperature regulation, maintaining neurological function, maintaining fluid & electrolyte balance, promoting normal GI function, adequate nutrition, promoting urinary elimination, Skin & wound care, maintaining/enhancing self-concept, Restorative & Continuing care.

Perioperative Nursing Assessment

Nursing/Medical/Surgical history, Risk factors, Medications, Allergies, Smoking habits, Alcohol/substance use & abuse, Pregnancy, Perceptions/knowledge of surgery, support sources, occupation, preoperative pain assessment, review of emotional health, cultural/spiritual, Physical exam

Acute care: intraoperative

Physical preparation, intraoperative warming, latex sensitivity/allergy, introduction of anesthesia, positioning the patient of surgery, documentation of Intraoperative care

General Anesthesia (GA)

Produces loss of consciousness including an absence of pain sensation; patient's vital signs (VS)—heart rate, breathing rate, pulse, & blood pressure—are carefully monitored when using a general anesthetic

Health promotion: perioperative teaching

Reasons for preoperative instructions & exercises, preoperative routines, surgical procedures, time of surgery, PACU & family waiting, postoperative monitoring & therapies, sensory preparation, postoperative activity resumption, pain-relief measures, Rest, & feelings regarding surgery.

Perioperative nursing

Refers to the role of the operating room nurse during the preoperative (before), intraoperative (during), and postoperative (after) phases of surgery.

Postanesthesia recovery score (PARS); Aldrete score

Score that measures various criteria, including oxygen saturation, level of consciousness, circulation, activity, & respiration.

Classification of Surgical Procedures

Seriousness - minor or major Urgency - elective, emergency, urgent Purpose - diagnostic, ablative, palliative, reconstructive/restorative, transplantation, constructive, cosmetic

Surgical Risk Factors

Smoking, Age (very young & old), Nutrition, Obesity, Obstructive Sleep Apnea (OSA), Immunosuppression, Fluid & Electrolyte Imbalance, Postoperative Nausea & Vomiting (PONV), Venous Thromboembolism

Regional Anesthesia

Temporary interruption of nerve conduction as produced by injecting an anesthetic solution near the nerves to be blocked. *epidural, spinal, caudal block*

Reverse Trendelenburg

The entire bed is tilted with the foot of the bed lower than the head; position promotes gastric emptying and prevents esophageal reflux

Scrub nurse

The surgical assistant (RN or surgical tech) hands instruments to the surgeon. This person wears sterile clothing & maintains the sterile operative field.

Association of periOperative Registered Nurses (AORN) & American Society of PeriAnesthesia Nurses (ASPAN)

The use of professional perioperative standards developed by AORN & ASPAN provides valuable guidelines for perioperative management & evaluation of process & outcomes.

Informed consent

When a consent is obtained preoperatively, it must be done before a patient receives any form of sedation to ensure a clear level of consciousness at the time of signing. *It is the surgeon responsibility to explain the procedure, associated risks, benefits, alternatives, & possible complications before obtaining the patient's oral & documented informed consent*

American Society of Anesthesiologists (ASA)

assigns classification on the basis of a patient's physiological condition independent of the proposed surgical procedure; ASA I= normal, II= mild systemic disease, III= severe systemic disease, IV= severe systemic disease & constant threat to life, V= Moribund patient, VI= brain dead/organ donor, E= Emergency

Local anesthesia

causes the loss of sensation in a limited area by injecting an anesthetic solution near that area

Nursing Care Plan (or the care plan)

includes nursing diagnoses, goals and/or expected outcomes, specific nursing interventions, & a section for evaluation findings so any nurse is able to quickly identify a patient's clinical needs & situation.

Tredenlenburg

lying with the head lower than the legs

Medication: shorthand notation for mode of administration.

po: by mouth pr: by way of the rectum (suppository) sl: sublingual IV: intravenous IM: intramuscular SQ: subcutaneous

Latex sensitivity

response to latex proteins in gloves & other medical equipment that usually leads to contact dermatitis