Periop nursing part 1
what are important safety measures of preop
- Ensure client is wearing proper identification, blood & allergy bands - Always wash hands - Ask client to explain in his/her own words what surgical procedure is being done and why ---If explanation is not consistent with documentation, notify surgeon to speak with client - Ensure client is not asked to sign consent form after preoperative drugs have been given - Ensure surgical site is marked (W/A) - Skin prep and colon prep completed (W/A) - Ensure NPO status - Medication reconciliation
what if the patient is DNR and is going into surgery, what needs to happen
- If they are a DNR, the physician must talk to the patient before surgery to go over the risk, and revocate the DNR for the surgery cause if anything was to happen during surgery they can't code them, but the DNR will become active again once the surgery is over
what are some settings for surgery
- ambulatory (a lot of surgeries are done here) - outpatient - same day/short stay - inpatient for those who are seriously ill, undergoing major surgery, or trauma patients
what are the 3 things you need informed consent on
- anesthesia - surgery - blood
what types of medications might be given in the preop phase
- anti-anxiety (benzo, benadryl)
what is the nurse's role in terms of advance directives
- ask the patient if they have one, if so ask them for a copy - if not ask them if they would like one
what are the nurses responsibility during the postoperative phase
- assessing for physical adaptation - assisting in orienting back to consciousness - communications of information with nursing unit/loved ones - prepare for discharge
what is an epidural block regional anesthesia
- awake, feels no pain - injected into the epidural space to decrease sensation for large areas
intraoperative nursing phase begins when
- begins when the client is transferred to the OR table and ends when the client is admitted to the PACU
preoperative nursing phase begins when
- begins when the decision to have surgery is made and ends when the client is transferred to the OR table
postoperative nursing phase begins when
- begins with the admission of the client to the PACU and ends when the healing is complete
what is a nerve block regional anesthesia
- block nerve impulses - it is injected in and around the nerve group
what are the final checks before transferring the patient
- consents - history and assessment - teaching - preparation - medications - give report to the OR nurse using SBAR - DOCUMENTATION
What happens if the patient changes their mind about the procedure after they have already signed the informed consent form
- have the surgeon come back to talk to the patient and revoke the consent
what does the nurse have to do during the preop in terms of safety
- identify the patient - make sure the informed consent and advanced directives are in order and signed - the OR checklist is complete (allergies, VS (baseline), last po intake (risk for aspiration), medications (drug-to-drug interactions) - anesthesia MD visited because the patient needs to know what type of anesthesia they are getting - timed out
define reconstructive.cosmetic surgery
- if face is messed up from a dog attack may need this
what happens if you need consent but the patient is confused and has no family
- if urgent, go to surgery - if not urgent the court will assign a legal guardian
what does the nurse need to make sure is done before medicating the patient
- informed consent is signed and that if they have any questions they are answered - any lab values that are abnormal
what kinds of procedures need IC
- invasive - ones that require sedation/anesthesia - non-surgical procedure that carries a higher risk - radiation procedures
what physical preparation needs to be done in the preop phase
- iv line (18 gauge cause can hold a lot of fluids) - bowel (want it empty) and bladder (may put foley in) - skin prep (shave)
what are some advance directives
- living will - durable power of attorney for healthcare - DNR status - RN's role - Application to surgical procedure
general anesthesia
- loss of all sensation adn consciousness - administered by IV or inhalation of gas - used for major surgeries
what is spinal anesthesia
- lumbar punctures into herroractic space - less anesthesia is needed
what can contribute to the risk of the surgery
- malnutrition - obesity - cardiovascular conditions - blood coagulation disorders - pulmonary disorders - renal disease - DM - liver disease
what is moderate sedation
- minimal sensation that they are conscious for - allows person to breath on their own and respond
define elective surgery
- needed but not necessary - will improve their life
define required surgery
- needed for the pt well being - weeks - months
define diagnostic/exploratory surgery
- needed in order to establish a diagnosis
what are the phases of surgery
- preop - periop -postop
define urgent surgery
- prompt attention - within 24-48 hrs
what are s+s of medullary depression
- pupil fixed and dilated - respiration weak - pulse rapid and thready
define reparative surgery
- repair the body - example: there are multiple wounds that need to be repaired because of an automobile accident
what main steps are in the preoperative phase
- safety - nursing assessment - medications - teaching - advocacy - complications
What if the patient is on a psychoactive medication and we need informed consent
- sorry, you cannot get informed consent if they have taken a psychoactive med - you had to get consent before you administered the drug, even if it is benadryl
define emergent surgery
- surgery has to be performed immediately to save the patient - unplanned (think gun shot)
what is the nurses role during the intraoperative phase
- taking care of the family - preparing patient for induction of anesthesia - maintaining homeostasis and asepsis - maintains safety - assisting surgeon and team
what if the patient is unconscious and you need informed consent
- the DOA, or legal guardian would have to sign off - if it is a life threatening emergency you do not need consent, it is inferred
what is the nurse's role in informed consent
- the nurse will ask if the signature is theirs, and if they have any questions to which you might have to call the surgeon back down to talk about the procedure
define palliative surgery
- to make a person more comfortable - example: removal of cranial nerves to prevent pain or correct a problem
what teaching needs to be done in the preop phase
- what to expect in the OR - what to expect in recovery - how to prevent post-operative complications
What does informed consent include?
-Patients condition -Purpose of recommended procedure -Explanation of risk -Alternative options -The possible outcome -Risk of declining or delaying procedure
what are the 4 stages of general anesthesia
1) drowsy and dizzy: decreased pain 2) irreg. breathing, involuntary movements (don't touch) 3) appropriate level of anesthesia for procedure (muscles relax, constriction of pupils, absent eyelid reflexes) 4) medullary depression: near death
what are the 3 requirements of IC
IC = informed consent 1) voluntarily 2) individual is capacity and competent 3) sufficient information is given to make an informed decision
cultural aspect of surgery: Jehovah's witnesses
NO BLOOD, the reason is that they believe that that is their spirit and they don't want to take someone else spirit
which of the following activities would the nurse carry out in the preoperative period for a client scheduled for surgery a) identify potential or actual health problems b) perform specialized procedures to assure safety c) assess client's responses to intereventions d) intervene to prevent complications
a
which of the following is the most important initial nursing activity in the postoperative recovery area a) maintain patient safety (airway and circulation) b) administer medications and fluids c) assess level of pain d) inspect the surgical site
a
a nurse knows that she must obtain a signed informed consent for which of the following procedures, select all that apply a) arteriography b) open reduction of a fracture c) insertion of a urethral catheter d) cystoscopy e) insertion of a peripheral IV f) paracentesis
a, b, d, f
there are 4 stages of general anesthesia. select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements a) stage 1: beginning anesthesia b) stage 2 excitement c) stage 3: surgical anesthesia d) stage 4: medullary depression
b
the perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. which of the following is the most important function a) completed the preoperative assessment b) develops a plan of care c) verifies that the operative consent is signed d) provides psychological support
c
all clients having surgery have a degree of risk associated with the surgery. the nurse would evaluate which of the following client-related factors as contributing to a high degree of risk associated with surgery a) institution reputation b) average nutritional status c) little likelihood of complications d) history of cardiac and pulmonary disease
d
the effectiveness of preoperative teaching will be most negatively influenced by a) the presence of a significant other during the teaching session b) concern regarding the amount of insurance reimbursement c) prior experience with surgery in family members d) pain unrelieved by medications
d
cultural aspect of surgery: mexican
family oriented, want family around like all the time
define optional surgery
gastric stapling to lose weight
what are the components of preadmission testing
happens before you step foot into the hospital - nursing assessment - diagnostic and lab tests - consent and advance directive forms - teaching - discharge planning - referrals for home care/rehab
cultural aspect of surgery: chinese
herbal first, don't show pain or weakness, they believe that the body has to stay intact cause they believe in reencardnation, so surgery would not keep the body in tact
what is the most common surgical error
leaving things in the patient
what is an example of a local regional anesthesia
litican for sutures
what are 4 types of regional anesthesia
local nerve block epidural block spinal anesthesia
what is regional anesthesia
loss of sensation to one part of the body
major vs minor surgery
major: more complications, higher risk, longer time, larger loss of blood, involvement of vital organs, minor: fewer complications and lower risk, one-day or outpatient surgery
what is anesthesia
partial or complete loss of sensation - can be conscious - can block nerve impulses - can promote relaxation
what does PAT stand for
preadmission testing
cultural aspect of surgery: pilipino
rely on the oldest child to make the medical decision for the parent, the oldest child may not be the DOA
define curative surgery
removal of a pathological cause (tumor)
cultural aspect of surgery: African Americans
statistically is that they receive less care, so there is a lot of distrust, so try to have an African American nurse help the patient so that there is more trust
who is responsible for informing the patient
surgeon
who is responsible for obtaining the signature
surgeon
