52B Exam III- C/R/S (Perioperative)

  1. what can be the effects of preoperative fear?
    it can be good, in normal amounts, by kicking in the sympathetic nervous system.
  2. what are people afraid of preoperatively? general and spacific
    • General
    • the unknown
    • loss of control
    • loss of love from significant other
    • Spacific
    • malignancy of tumor
    • anesthesia
    • dying
    • pain
    • disfigurement
    • permanent limitations
  3. list, and define, the 5 reasons for surgery (mnemonic?)
    • 1. Diagnostic: finds origin/cause of disorder (exploaratory laparotomy)
    • 2. Curative: resolves a health problem (mastectomy)
    • 3. Restorative: improve functional ability (knee replacement)
    • 4. Palliative: relieve symptoms (tumor debulking)
    • 5. Cosmetic: enhance physical appearance (facelife)
  4. what are the different urgencies of surgery?
    • Elective
    • Urgent
    • Emergent
  5. explain simple vs radical surgery
    • simple-removal of tissue only
    • radical-removal of tendons and muscle too (radical mastectomy)
  6. what can severe preoperative anxiety lead to?
    • difficult postop care
    • anger
    • depression
    • confusion
  7. what are two types of preop pediatric anxiety? how can we help them?
    • seperation anxiety (keep parents around as much as possible)
    • unfermilliar surroundings (take pt to rooms before operation, use "play activities")
  8. what is the #1 anxiety intervention?
    preop teaching to answer questions and decrease anxiety
  9. what are the effects of stimulating the alpha, beta1, and beta2 adrenergic receptor sites?
    • alpha - vasoconstriction
    • beta1 - + Inotropic effects (increase force of heart contractions), and + Chronotropic effects (increase in heart rate)
    • beta2 - vasodilation and increased renin release from kidneys
  10. what is the neuroendocrine response to surgery?
    alpha and beta receptor cites are stimulated (sympathetic ns activated) causing vasocnstriction (helps maintain BP), and + Inotropic/Chronotropic effects on heart (maintains BP and helps perfuse vital organs)
  11. what is the effect of surgery on the GI system?
    decreased activity - can lead to constipation, gas pain, and anorexia
  12. what is the effect of surgery on metabolism/blood glucose? what are two potential problems?
    • glucocorticoid secretion for the adrenal cortex is increased. this increases the breakdown of protein, CHO, and fats for healing and energy.
    • this can cause weight loss or high blood glucose (so watch in diabetics)
  13. what effect can sergury have on the urinary system? what can they lead to?
    • increased ADH secretion can cause increased fluid volume/fluid overload
    • Na retention by kidneys (renin-angiotension system activation) can cause increased fluid volume and K loss (bad for muscle/heart function)
  14. explain the renin-angiotensin system (RAS)
    • decrease in blood volume (ex: from surgery) causes kidneys to release renin
    • renin stimulates angiotensin production, constrict blood vessels, and increases adosterone secretion from the adrenal cortex
    • aldosterone causes Na resorption in tubules of the kidney which holds on to water and increases blood volume
  15. what are some risk factors for surgery?
    • age- altered physiological respense, presence of chronic disease
    • duration of surgey
    • smoking
    • nutrition- malnutrition (decrease resources for healing), obesity (heavy chest = resp issues, wound seperation increase, DVT form decreased movement)
  16. how can chronic diseases be a risk factor for surgery in older adults?
    • Chronic pulmonary disease - (COPD) don't respond well to anesthesia, prone to infection (pneumonia), C02 retention
    • Cardiovascular - meds must be adgustes, atherosclerosis inhibits blood vessel constriction
    • Renal - electrolyte imbalances, decreased kidney function (means they can't excrete anesthesia so doses must be lowered)
    • Diabetes - decreased wound healing
  17. how is smoking a risk factor for surgery?
    • irritates bronchus
    • increases secretions
    • decreased ventilation/ability to remove secretions
  18. what goes into the preop prep of a pt?
    • informaed consent
    • teaching (routines, where they will be, equipment, treatments-dressing change, pain managment, TCDB, how to pillow splint, IS, hob up 30-45 degrees)
    • NPO 6-8 hr before
    • bowel prep
    • preop meds
    • checking labs/tests (CBC, UA, ECG, X-ray, coag)
    • skin prep
  19. what are some side effects to watch for from a preop bowel prep?
    • cramping
    • dehydration
    • electrolyte imbalance
    • fatigue
    • vasovagal response (decrease blood to brain can cause pt to pass out)
    • irritation
  20. list functions of preop meds
    • reduce anxiety (valium)
    • promote relaxation
    • reduce pharyngeal/gastic secretions (atropine-also inhibits GI motility)
    • prevents laryngospasms
    • decreases amount of anesthesia needed
  21. what are the procedures for an informed consent
    • pt must be...
    • -mentally and physically competent (no opiats onboard)
    • -a legal adult
    • must be voluntary
    • pt must understand procedure, risks, benifits, and alternatives
    • pt must have had all their questions answered satisfactorily
    • interpreter must be used if necessary
  22. what is the ONLY duty of the RN in regards to an informed consent?
    to witness signature (can reinforce teaching)
  23. what can happen if pt is not informed before signing an informed consent? what are osme exeptions?
    • charges of assault and battery or negligence
    • exceptions:
    • -emergency
    • -waived right
    • -physician invokes therapeutic privilege
    • -obvious risk
    • -risk couldn't be predicted
  24. what is used for a preop skin prep?
    betadine or chlorhexidine body scrub/wipes 1-2 days before OR
  25. what is pillow splinting?
    bracing incision/abdomen by holding a pillow
  26. what factors make a pt high risk for pulmonary complications?
    • thoracic/upper abdominal surgery (pt won't want to deep breathe due to pain)
    • smoking
    • chronic lung disease
    • tight abdominal binders/body casts
    • obesity (don't breathe deeply)
    • elderly
  27. what are some leg exercises and why are they important postop?
    • ankle pumping and gluteal squeezes
    • they promote venous return (venous stasis can cause DVT formation whcih can lead to pulmonary emboli)
  28. why is it important to ambulate a postop pt soon after surgey?
    • prevents decubitus ulcers
    • increases peristalsis
    • decreases pain
    • reduces risk of DVT
  29. what is the final prep before sending a pt to the OR?
    • (see preop checklist)
    • check ID band
    • NOP
    • empty bladder (if not cathed)
    • check allergies
    • advanced directives (DNR status)
    • give "en rout to OR" preop meds
    • RN to sign off
    • to OR by guerney
  30. define concious sedation
    reduction of LOC with IV drugs
  31. what is the purpose of concious sedation?
    • to dull/decrease intensity or awareness of pain
    • reduce LOC while keeping defensive reflexes (gag reflex=no need to intubate)
  32. who decided if a pt is a candidate for concious sedation?
    the MD
  33. in what cases is concious sedation used?
    • endoscopies
    • cardiac caths
    • closed fracture reduction
    • PTCA (percutaneous transluminal coronary angiogram-like a cardiac cath)
    • cardioversion
    • electric convulsant therapy
    • other special but short procedures
  34. what is the prep for concious sedation?
    • NOP for several hours
    • informed consent signed
    • baseline VS
    • special procedure room/PAC Unit (post anesthesia care unit)
  35. how is concious sedation usually administered?
    direct IV push
  36. concious sedation is a combination of what types of drugs? give examples
    • Opioids - demerol, morphine, fentanyl
    • Sedatives/hypnotics (benzodiazapines) - valium, versed, ketamine
  37. what are the nursing responsibilities during surgery? who supervises?
    • the MD supervises and the RN must...
    • have advanced training in IV med administration
    • manage airway and ACLS (advanced cardiac life support)
    • monitor airway, LOC, ECG, 02sat, VS q 15min (until fully awake and responsive)
  38. what is given to reverse concious sedation meds?
    • Narcan for Opioids
    • Romazicon for benzodiazepines (both have "Zs" in them)
  39. what are the 5 perioperative staff/team members?
    • circulating nurse
    • scrub nurse/surgical tech
    • specialty nurse
    • surgeon and surgical assistant
    • anesthesiologist or CRNA (certified RN anesthesiologist)
  40. what is a "time out"?
    when the entire team stops to varify that it is the correct patient, procedure, and site
  41. what are some risks related to body positioning of pt perioperatively?
    • burning from improper grounding during electrocautery (electric cauterization)
    • pressure ulcer formation
    • obstruction of circulation/respiration/nerve conduction
  42. what is laproscopic surgery?
    surgery using toold inserted through small incisions instead of one large one.
  43. what can cause shoulder pain after laproscopic abdominal surgery? how can if be fixed?
    C02 is used to inflate the abdomen and, if it isn't all removed before incisions are sutured, when the pt sits up it can travel up to the shoulders and cause pain. have pt lay down until C02 can be absorbed by the body
  44. define steril, clean, and contamination
    • steril - free from living microorganisms
    • clean - free from dirt
    • contaminated - the introduction of dirt of microorganisms onto something formerly clean or steril
  45. how far should a non-steril person be from anything steril?
    12 inches
  46. what areas of a gown are considered steril?
    • the waist to the shoulders
    • and
    • the sleeves to 2 inches above the elbows
  47. define general anesthesia
    reversable loss of conciousness by inhibiting CNS
  48. define regional anesthesia
    temporary disruption to spacific are of sensation (epidural, spinal, nerve block)
  49. define local anesthesia
    directly applies anesthesic agent (topical)
  50. what is malignant hyperthermia?
    an inherited disease where pt experiences a drastic rise in temperature when given anesthesia
  51. what are some complications from general anesthesia?
    • malignant hyperthermia
    • overdose of anesthesia (pt won't wake up)
    • unrecognised hypoventilation (lungs don't fully fill when ventilated)
    • complications with spacific anesthesia agents (can cause kidney, heart, GI paralysis)
    • intubation complications
  52. how is general anesthesia administered?
    • inhalation: intake and excretion of anesthesia by lungs via a mask
    • IV injection: barbiturates, katamine, and propofol through the blood
  53. what are some adjuncts to general anesthetic agents?
    • hypnotics
    • opioid analgesics
    • neuromuscular blocking agents
  54. what can cause postop shock?
    • moving pt from table to bed
    • jarring guerney during transport
    • reactions to drugs/anesthesia
    • loss of blood/body fluids (check EBL)
    • cardia arrhythmias/heart failure
    • inadequate ventilation
    • pain
    • decreased sympathetic response
  55. what is the purpose of the PACU recovery room?
    provide ongoing evaluation and stabalization of patients to anticipate, prevent, and treat complications after surgery
  56. why should a postop pt be turned on thir side?
    to prevent tongue from closing off their airway
  57. how much drainage is too much postop?
  58. what is the #1 nursing diagnosis postop?
    pain can be either the diagnosis or etiologic factor)
  59. who should you not give demerol and why?
    children, because it produces toxic metabolites
  60. what are some advantages to a PCA?
    • increased satisfaction with pain control so pt uses less
    • decreased pulmonary complications
    • earlier ambulation
    • shorter hospital stay
  61. who should always be in control of the PCA?
    the patient! no PCA by proxy
  62. what are three tips for monitoring a PCA?
    • consistantly use a pain/sedation rating scale
    • follow standard policy for monitoring over-sedation and adverse reactions
    • assess sedation using minimal spoken and tactile stimulation
  63. what are some common GI reactions following surgery?
    • N/V
    • decreased or absent paristalsis (due to anesthesia time, bowel handling, and opioid use), can last up to 24 hours
  64. describe the 4 phases of wound healing (give time frames for each)
    • Phase I - (1 to 3 days) inflammatory response, blood flow reestablished
    • Phase II - (3 to 14 days) collagen fills in (epithielization)
    • Phase III - (2-6 weeks) more collagen and compression of blood flow
    • Phase IV - (several months) shrinking and contraction of scar
  65. when can ineffective wound healing most often be seen?
    between the 5th and 10th days after surgery
  66. what is dehiscence?
    partial or complete seperation of the outer wound layers (splitting open)
  67. what is evisceration?
    total seperation of all wound layers and protrusion of internal organs
  68. when and how often should dressings and drains be assessed for drainage postop?
    on admission to the PACU and hourly thereafter
  69. what function do drains serve?
    they provide an exit for air, blood, and bile to prevent deel infections and abscess formation during healing
  70. how are wound infections treated
    antibiotics and irrigations
Card Set
52B Exam III- C/R/S (Perioperative)
52B Exam III- C/R/S(Perioperative)