Preoperative
Name five things to remove from the preoperative client prior to going to preop holding?
Remove dentures/bridges
Remove nail polish
Remove jewelry
Remove undergarments, some surgeons may allow cotton underwear only
What types of conditions impact or place a person at risk during surgery?
Smoking
Diabetes
Obesity
Structure conditions such as kyphosis
Describe the difference in wound dehiscence and evisceration.
Dehiscence is a separation of the incision, more prone to open heart and/or abdominal surgeries
Evisceration is evidence of bowel through the incision and will have increased pain.
Explain what a JP drain is and how to manage the care.
Jackson Pratt
Usually for draining blood. Relies on self-suction. Do not allow to become half full. Pen to gown, do not let it dangle. Record output. Face shield when emptying as is a risk for exposure.
Need this on client's chart who is going to surgery? At least 6 things
Informed consent
Lab work
Preop teaching
Medication record
Abnormal lab values
Preop checklist
The surgeon is responsible for discussion this with the surgical client but the nurse must make sure it is on the chart before going to surgery?
Informed consent
Signed
Explain perioperative tissue injury.
Injury due to prolonged positioning during surgery.
Can also be from incorrect positioning or inadequate padding.
5 clinical manifestations of a paralytic ileus.
A paralytic ileus is not uncommon after surgery. It is a condition where the normal movement of the intestines is slowed or stopped. This can cause a buildup of food or gas in the intestine.
5 signs/symptoms: absent bowel sounds, or a decrease/hypoactive; no stool or flatus; nausea; vomiting; abdominal distension, abdominal tenderness.
Let's talk about abdominal girth.
Explain about a Hemovac drain.
Usually for draining blood. Relies on self-suction. Is accordion-shaped. Do not allow to become half full. Pen to gown, do not let it dangle. Record output. Face shield when emptying as is a risk for exposure.
Name signs/symptoms of DVT. Name 4 to 5.
Edema to the extremity
Warmth
Red/pink streaks
Painful such as calf pain (Homan's sign is contraindicated)
Change in color and temperature
What two things go on the client before sending them down for surgery?
ID bands, allergy, name, code status
Explain reasons for fluid imbalance during surgery.
Hypovolemia due to fluid loss, blood loss
Urine output issues
Name signs of infection including the incision site.
Incision site: REEDA (redness, edema, ecchymosis, drainage, approximation)
Fever (remember postop may be slight temp elevation due to dehydration from NPO then hypovolemia)
Tachycardia
Leukocytosis-increased WBC count, sign of infection
Explain about a penrose drain.
Risk for skin breakdown.
Sterile pin during placement but not sterile afterwards
Pin is to decrease the chance of it slipping back into the wound.
Possible urinary retention. Postop client is unable to void 8-10 hours postop? What steps in order should the nurse do?
Visualize for bladder distention
Palpate suprapubic area
Bladder scanner
Client may c/o pain in suprapubic area.
If catheter in place "trace the line"
Explain about preop medications.
Must be given as prescribed.
Some will be ordered the evening or morning of.
Some will be ordered "on call" to surgery.
Make sure to document and if not given make sure to document and communicate this to surgery.
Explain malignant hyperthermia related to surgery.
From the inhaling of anesthesia. May occur during or in recovery period.
Often is from an inherited gene.
This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms. Without prompt treatment, the complications caused by malignant hyperthermia can be fatal.
Signs of atelectasis? Name six
Dyspnea
Tachypnea
Decreased breath sounds
Asymmetrical chest movement
Tachycardia
Increased restlessness
Including, type of pressure
Role of nurse during insertion
Management such as dressing, kinks, taping
Intake & output
Dislodging from insertion site vs. from canister
Surgically inserted tube into the chest wall into the pleural space or mediastinum to remove substances such as air, blood, or infection or it may be inserted to reinflate a lung.
Closed drainage
Don't tape to the floor
Every shift output
Watch for low input then all the sudden increased or blood goes away and then back
Output is important for removal
Pulls from patient, 3 sided dressing
Pulls from canister replace
Do not milk or strip chest tubes
Dyspnea
Increase RR
Tachycardia
Increase anxiety
Diaphoresis
Decreased orientation
Hypotension
Blood as changes, the clot blocks blood flow resulting in hypoxemia and hypocapnia/low CO2
What preop teaching should be done?
and what is the best evaluation of this education?
Explain, the process such as holding, surgery, postoperative
Official time out
Incentive spirometer
CTDB
Ambulation
Pain management
Decreasing risk of postop complications: DVT, pneumonia
Explain perioperative hypothermia.
From wet/cold preps.
OR is kept cold to decrease risk of infection.
Name clinical manifestations of pneumonia. Nine would be fine.
Tachypnea
Shallow respirations
Fever
Wet breath sounds
Asymmetrical chest movements
Productive cough
Hypoxia (what is an early sign of hypoxia)
Tachycardia
Leukocytosis-Increase WBC count, indicative of infection
List different types of urinary catheters
Discuss prevention and care.
Indwelling often called Foley, now explain some about foleys
Suprapubic-a permanent urinary cath which is surgically placed through the peritoneum of the abdomen. Meticulous care to site.
Straight cath, intermittently placed
3-way cath, can do CBI
Coude cath, special cath made for use for enlarged prostate. Is curved.
Diet for the preop client is?
NPO