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Explain the goals of perioperative nursing
- -Client safety
- -Most optimal recovery
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Describe essential components of preoperative nursing:
- Assessment:physical, psychosocial, health Hx, Head-2-Toe, medications, allergies
- Diagnostic Tests:CBC, U/A, CXR, ECG, PT/PTT/INR, ABGs, pulse Ox
- Teaching: 3 types - Sensory, Procedural, Process
- Informed Consent:understood by Pt, volentary (signed b4 being medicated), confirm signage, witness signature
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Develop a preoperative teaching plan for a client undergoing open abdominal surgery.
(ND & interventions)
- -NDs:Deficient knowledge, Anxiety, Anticipatory grieving, Risk for injury
- -wound care
- -deep breathing & coughing exercises, I.S.
- -leg/foot exercises 2 prevent thrombi/DVTs
- -turning/positioning/ambulation
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Describe the action, therapeutic effect, and nursing implications of medications
administered during the preoperative period.
- -Antibiotics: prevent post-op infections
- -Antidiabetics: stabilize blood sugar
- -Anticholinergics: decrease oral secretions
- -Anti-emitics: decrease nausea/vomiting
- -Beta Blockers: manage HTN
- -Benzodiazepines: sedative
- -H2 receptor blockers: decrease gastric vol. & secretions
- -Narcotics/Opioids: treat pain,
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Identify the surgical team (OR team) and describe their role in client safety.
- Surgeon:team leader, performs procedure
- Surgical assistant: exposes tissue, sponging, suctioning, suturing
- Anesthesiologist: focused assessment, IVs, meds, anesthesia, continuous monitoring
- Circulating RN:coordinator, documentation
- Surgical tech/Scrub nurse:handles sutures, instruments, equipment
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Types of anesthesia.
- -general
- -regional
- -local anesthesia
- -monitored anesthesia care (MAC)
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Describe features of Conscious Sedation
- -Pt responsive
- -IV narcotics & anti-anxiety meds
- -strict protocols
- -special training
- -Ex: closed reduction of fracture, colonoscopy, burn dressings cardiac catheterization
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Goals of Conscious sedation
- -Priority is airway
- -keep Pt. moderately sedated
- -Pt maintains airway, follows commands, verbal
- -reversal agents: Narcam, Romazicon
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Describe the role of the nurse related to conscious sedation and explain potential risk factors
- -Consent
- -Universal protocol
- -Assessments/teaching
- -monitoring VS
- -med admin, IVs, & airway monitoring
- -O2 admin
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Measures to maintain client safety during the intraoperative phase
-Infection control
-Universal Protocol: time-out 4 final assessment
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Explain the role of the PACU nurse
- -Goal: to discharge from medical care
- -ABC priority
- -Interventions: jaw-thrust, positioning, suctioning
- -Report
- -Intensive monitoring: cardiac/resp.
- -airway obstruction?
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Name 5 Post-Op Respiration complications
- -Atelectasis: alveolar collaspe
- -Hypoxemia: pulmonary edema, aspiration
- -Hypoventilation: CNS depression
- -Pneumonia: alveolar inflammation
- -Pulmonary embolism (PE): obstr of plumonary artery
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Name 2 Post-Op Cardio complications
- -Hemorrhage/shock: rapid loss of large amts of blood. (EBL)
- -Thrombophledits: clot formation and inflammation.
- -Homan sign: pain on forced dorsi-flex of foot
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Interventions for Post-Op Respiratory complications
- -o2
- -Deep breathe & coughing
- -IS
- -turning/repositioning
- -early amblulation
- -antibiotics, IV fluids, anticoagulation
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Interventions for Post-Op Cardio complications
- -o2
- -IV fluids
- -Blood products
- -positioning (Trendelenburg-supine/legs loft)
- -anticoagulation
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Anticoagulation medication
- Lovenox (enoxaparin)
- -theraputic: anticoagulant
- -pharmacologic: antithrombotic
- -MOA: binds to antithrombin 3 =>deactivate factor X and thrombin => prevents conversion of fibrinogen to fibrin
- -Dangerous: does confirmed by 2nd nurse
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Name 6 commonly used Pain Medications
- -therapeutic: opioid analgesic
- -pharmacologic: opioid agonist
- -action:binds to opiate receptors in CNS changing Pt's perception/reacion to pain
- -Morphine
- -Demerol
- -Fentanyl
- -Hydromorphone
- -Hydrocodone
- -Oxycodone
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Acute pain
- Acute
- -sudden onset
- -less than 6 months
- -mild to severe
- -usually identifiable
- -decreases and/or resolves overtime
- -elevated HR, RR, BP, anxiety, agitation
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Chronic pain
- -gradual or sudden onset
- -greater than 6 months
- -cause may be unknown
- -mild to severe
- -waxes and wanes
- -flat affect, fatigue, social ioslation
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Pain Assessment
- -P provokes
- -Q quality
- -R region
- -S severity
- -T timing
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ABCDEFG
- Airway
- Breathing
- Circulation
- Dressing/Drains & Disability
- Environment
- Full set of VS
- Give comfort measures
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Methods of pain reilfe
- -Repositioning
- -reduce anxiety
- -reduce environmental stimulus
- -distraction
- -medication
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