-
Define perioperative nursing care.
Nursing care preoperative, intraoperative and postoperative.
-
Describe the reasons for which surgery is preformed.
- Diagnostic
- Curative
- Pallative
- Preventative
- Explorative
- Cosmetic Improvement
-
Determine how surgical procedures are classified.
-
List factors to include in the assessment of the surgical patient.
- Psychosocial
- Past Health Hx
- Medications
- Allergies
- ROS
- Physical Exam
- Labs
- Dx Testing
-
Describe how to correctly witness a patient's informed consent for surgery.
- Does the pt u/s all the information presented?
- Was all information disclosed to the pt?
- Are they signing voluntarily?
-
Explain the preoperative check list.
It ensures all pre-op preparations have been completes before and sedating meds are given.
-
Identify the routine screening tests for surgical patients and identify what the results tell us about the preoperative patient.
- Urinalysis: renal status, hydration, UTI and disease
- CXR: pulmonary disorders, cardiomegaly
- RBC,Hb,Hct,WBC,WBC c dif: anemia, infection, immune status
- Electrolytes: metabolic status, renal fx, diuretic side effects
- ABG's & Oximetry: pulmonary and metabolic fx
- PT,PTT,INR & Platelets: bleeding tendencies
- Blood Glucose: metabolic status, DM
- BUN & Creat: kidney fx
- Serum Albumin: nutrition
- EKG: heart disease and electrolyte abn
- LFT's: liver fx
- Type & Cross: blood availability
- Hcg: pregnancy
-
Describe factors that place the older adult at risk for surgery.
- Increase anxiety
- Decreased organ fx
- Increase in other illnesses
- Increase stress
- Increase risk of complications
-
Identify the effects of medications taken preoperatively: Antiarrhythmics, antihypertensives, corticosteroids, anticoagulants, antiseizure, gloucoma and antidiabetic medications.
-
Identify the content of preoperative teaching as it relates to a pt's postoperative recovery.
- Instruct pt on deep breathing, coughing and moving
- Tell pt abt any equiptment, tubes and drains
- Incentive spirometry
- PCA
- Sx specific info
- Where they will wake up
-
Define and contrast the types on anesthesia (including conscious sedation) as to their effect on the pt.
- General: loss of sensation with loss of consciousness
- Local: lossof sensation without loss of consciousness
- Regional: loss of sensations to a region without loss of consciousness, also when a specific nerve is blocked with a local anesthetic
-
Examine the nurses role in the OR.
- Circulating/Nonsterile Activities:
- -Reviews anatomy, physiology and the sx procedure
- -Assists with preparing the room
- -Practices aseptic technique in all required activities
- -Monitors practices of aseptic technique in self and others
- -Ensures that needed itsms are available and sterile if required
- -Checks mechanical and electrical equiptment and environmental factors
- -Identifies and admits the pt to the OR suite
- -Assesses the pt's emotional and physical status
- -Plans and coordinates the intraoperative nursing care
- -Checks the chart and relates pertinent data
- -Admits the pt tp the operating room suite
- -Assists with transferring the pt to the OR bed
- -Ensures pt safety in transferring and positioning the pt
- -Participates in the insertion and application of monitoring devices
- -Assists with the induction of anesthesia
- -Monitors the draping procedure
- - Documents the intraoperative care
- -Records, labels and sends to proper locations tissue specimens and cultures
- -Measures blood and fluid loss
- -Records the amt of drug used during local anesthesia
- -Coordinates all activities in the room with team members and other health related personnel and departments
- -Counts sponges, needles and instruments
- -Accompanies the pt to PACU
- -Reports information relevent to the care of the pt to the PACU RN
- Scrubbed/Sterile Activities:-Reviews anatomy, physiology and the sx procedure
- -Assists with preparation of the room
- -Scrubs, gowns and gloves self and other members of the sx team
- -Prepares the instrument table and organizes sterile equipment for functional use
- -Assists with the draping procedure
- -Passes instruments to the surgeon and assists by anticipating their needs
- -Counts sponges, needles and instruments
- -Monitors practices of aseptic technique in self and others
- -Keeps track of irrigation solutions used for calculation of blood loss
- -Reports amount of local anesthesia and epinephrine solutions used by ACP and/or surgeon
-
Describe the principles of basic aseptic technique in the OR.
- All materials that enter the sterile field must be sterile
- if a sterile item comes in contact with an insterile item its contaminated
- contaminated items should be removed
- sterile team members must wear only sterile gowns & gloves
- once dressed only the front of the gown from the chest to the table and the sleeves up to 2" from the elbow are sterile
- tables are only sterile at table top level
- package ends are unsterile once the package is open
- bacteria travel through capillary action such as moist fabric
- bacteria harbor on pt's and team members hair, skin and respiratory tracts and must be confined with appropriate attire
-
Describe malignant hyperthermia and identify treatment modalities.
- Rare metabolic disorder where pt's have hyperthermia and rigid skeletal muscles that could cause death.
- Definitive tx is prompt administratio of Dantrium, it slows metabolism, along with symptomatic support to correct hemodynamic instability, acidosis, hypoxemia and elevated temp
-
Identify criteria used to evaluate the pt's readiness for d/c from the PACU.
- awake
- stable VS
- no excess bleeding or drainage
- no respiratory depression
- 02 sat above 90%
- report given
-
Describe the care of the pt in the immediate PO period on admission to the clinical unit.
- Monitor and manage respiratory and circulatory fx, pain, temp and sx site
- Goal is to ientify actual or potential problems that may arise as a result of the sx or anesthesia and intervene appropriately
- AIRWAY: for patency, oral or nasal airway and trach tube
- BREATHING: RR & quality, ascultate breath sounds, pulse ox and supplemental O2
- CIRCULATION: EKG monitor, BP, emp & skin color and peripheral pulses
- NEUROLOGICAL: LOC, orientation and sensory motor status
- GENITOURINARY: I&O
- SX SITE: dressing, drainage
- PAIN: incisional or other
-
Identify tasks that can be delegated to assistive nursing personnel.
-
Describe the use of ESI analgesia and PCA for PO pain management.
Goal is to provide immediate pain relief and maintain a steady blood level that allows for early ambulation, improved wound healing and earlier d/c
-
Identify PO complications and the assessments and interventions to correct them.
- Airway obstruction
- Hypoxia
- Hypoventilation
-
Review the care of a pt undersoing cataract sx.
-
For individuals s/p sx, what symptoms or situations would require the RN's immediate attn? (Prioritization)
|
|