MedSurg I Perioperative

olanjones's version from 2016-10-10 14:39

Reasons for Surgery & Suffixes

Question Answer
Curativeremoval of diseased organ
Palliativeincrease comfort but not curative
Cosmeticrevise a scar
Preventativeremove precancerous lesions
Explorativedetermine extent of disease
-ectomyExcision or removal of; Appendectomy
-lysisDestruction of; Electrolysis
-orrhaphyRepair or suture of; Herniorrhaphy
-oscopyLooking into; Endoscopy
-ostomyCreation of opening into; Colostomy
-otomyCutting into or incision of; Tracheotomy
-plastyRepair or reconstruction of; Mammoplasty

Standards for Ambulatory Surgery

Question Answer
AORNAssoc of Perioperative RNs - Ambulatory surgery centers need written policies and procedures for preoperative patient care.
Policies & Procedures should includeStaffing, Preadmit assess, Preadmit testing, Anesthesia eval, Preop teaching, Preop nursing assess, Documentation of preop nursing assess, Fast-tracking, Postop infection prevention, Outcome monitoring
Perioperative Nursing Data Set (PNDS)Vocabulary describing periop nursing - includes perip nursing diagnoses, interventions, & outcomes. Should be used to develop ambulatory surgery patient plans of care and to standardize nursing documentation
StaffingAdequate number and mix of personnel to meet patient care needs, Should be trained in CPR and use of emergency equipment
Preadmit AssessmentDetermine, baseline physical assess, allergies & meds (inc anesthesia hx), pyschosocial (abuse, culture, economic), preop tests, pre & postop teaching, referrals, consent, documentation
Preop TestingDiagnostic testing, H&P should be performed in timely manner. History and physical should be reviewed immediately before surgery, and any changes to the patient’s condition should be documented.
Anesthesia EvalDetermine if pt should have moderate or deep sedation, or anesthesia. Inc: medical hx, med/anesthesia use, ASA status classification, test results, planned anesthesia choice
Preop TeachingDescribe periop routine care (meds/showers/food), prep phase, length, management of pain/nausea, D/C, continuation of care
Preop Nursing AssesOn day of surgery, verify preadmit assess info. RN ensures that preop assess is complete and the patient’s emotional needs are met. RN analyzes the assessment data to determine nursing diagnoses and care plan
Postop Infection PrevWhen prophylactic abx recommended, which is appropriate, timing & route, who is responsible for obtaining, preparing, & admin
DocumentationInc: Preadmit survey, Preop nurse assess, consent, telephone message/f/u permission, H&P, Test results, Preanest asses, Pain scale asses, Risks, Sx procedure & site, Advance direct, Teaching/instruction
Outcome MonitorCollect data to monitor facility performance (pt perception of care, tx, service provision, needs/expectations met, infections, improvement)


Question Answer
What are the 5 main components of Preop?Teaching, Informed consent, Psychological prep, Physical prep (baseline), Immediate preop nursing interventions
What are common fears?Pain/discomfort, the unknown, mutilation, death, anesthesia, disruption of life pattern
What should be covered in interview?History, Meds, Nutrition (inc. herbs), Allergies
Objective dataHead-to-toe Physical Assessment for baseline, Ordered labs & diagnostic tests
Assessment should determineAdequate health to undergo surgery; Identify(& fix) operative risks; Where sx is done (inpatient/outpatient/same-day); Est baseline for postop comparison; Anesthesia type & technique; Plan preop care
Respiratory conditionsNotify anesthesia/op team, Plan for postop care/risks (atelectasis, hypoxemia), Preop teaching for client
Renal conditionsNotify anesthesia/op team, Plan for postop care/risks (F&E imbalance, coag, infection/healing risks, voiding prob), Preop teaching for client
Skin conditionsConsider padding, hydration, positioning
Musculoskeletal conditionsConsider positioning, ambulation, airway, spinal access
Teaching should includeWhat to expect, Preop regimen, Immediate/Recovery postop, Pain intervention, Demonstrate actions pt will need to perform

Informed Consent & Immediate Preop

Question Answer
Informed ConsentLEGAL, Should be in plain language, Is surgeon's responsibility but RN usually signature witness (advocate for patient - are they informed?)
Exceptions for informed consentMinors (parent/guardian to sign), Incompetent (guardian), Emergency (DOCUMENT)
When should consent form be signed?PRIOR to pre-op drug administration
What are the components of informed consent?Adequate disclosure, Sufficient comprehension, Voluntarily given, Signed before preop meds are given
Are preop checklists the same in all facilities?They may vary some between facilities but all contain similar info (VS, Chart/Diag/Final Chart reviews, Proc, Valuables, etc)
What must be done just prior to procedure?Gowned, No make-up/nail polish, Completed records, Valuables locked-up, Prostheses removed, Voided, Pre-op meds
Should hearing aids be removed prior to surgery?No (if possible) so client can hear in PACU

Pre-op Meds

Question Answer
Sedatives & Amnesiacsbenzodiazepines / barbiturates = anxiety reduction
Antiocholinergicsscopalamine / atropine / gycopyrrolate = decrease secretions, prevent N&V, sedation, prevent bradycardia
Opioidsmorphine / fentanyl = Reduce anesthesia requirements & pain of preparation
Antiemeticsmetoclopramide / ondansetron = Increases gastric emptying, prevent N&V
Antibioticscefazolin = prevent postop infection (timed for peak bacteremia)
Rx for patient's co-existing conditionsbeta blockers (reduce HTN), H2 blockers (decrease HCl acid, increase pH, decrease gastric volume), insulin (stabilize blood glucose)


Question Answer
CranberryUse: Prevention of UTI , AE: GI upset/diarrhea in excessive amounts
GarlicUse: Decrease chol, AE: Increase bleed, Lower blood glucose (fish oil, Vit E can also increase bleed risk)
GingerUse: Treat N/V, AE: Increase bleed risk, Lower blood glucose
Ginkgo bilobaUse: Symptoms of claudication, AE: Increase stroke risk, Increase bleed risk, Affect blood glucose
GinsengUse: Improve mental performance, lower blood glucose, enhance immunity, AE: increase/decrease in BP, Increase bleed risk,
St. John's wortUse: Depression, AE: Interferes with drug metabolism, Increase SE if used with other antidepressants
Why are kava and valerian a surgical risk?Both herbs can cause excess sedation
When should herbs be discontinued?Ideally 2-3 weeks before surgery

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