Preoperative
What is informed consent?
Form that must be signed by the patient prior to surgery, states they understand risks, benefits, and alternatives
What is a time-out?
Safety procedure prior to surgery involving a purposeful pause, verifying client identify, procedure, and surgical site
What should be monitored in a patient immediately post-operatively?
Vital signs
Airway
Level of consciousness
Wound assessment
What is UAP?
What personnel are considered UAP?
Unlicensed Assistive Personnel
CNAs, PCTs, CMAs
Procedures, actions, and processes that a health care practitioner is permitted to undertake in keeping with the terms of their professional license
What is scope of practice?
Why are patients kept NPO before surgery?
Aspiration risk of gastric secretions
What is malignant hyperthermia?
Inherited life threatening complication of certain anesthesia drugs. Characterized by tachycardia, muscle rigidity, tachypnea, hypotension.
Treated by administering dantrolene sodium, a muscle relaxant
What is DVT? How can it be prevented?
Deep vein thrombosis - blood clot in a vein
Encourage early ambulation after surgery
Leg exercises (ankle pumps, calf stretches)
SCDs, TED hose use as ordered
What determines the scope of practice for RNs and LPNs?
The state's Nurse Practice Act
Surgery performed to remove or treat the cause of a disease, providing a cure or permanent resolution.
What is curative surgery?
What chronic conditions increase surgical risk?
Diabetes, cardiac disease, renal disease, bleeding disorders
Why is it important to assess for a family history of anesthesia complications?
Genetic predisposition to malignant hyperthermia.
What is atelectasis? How can it be prevented?
Collapse of part of all of a lung due to alveoli deflating
Encouraging incentive spirometer use (Q1-2hr)
Coughing and deep breathing
Early ambulation
What tasks are inappropriate to delegate to LPNs?
Don't delegate what you can't EAT
E - Evaluate
A - Assess
T - Teach
Also - Initiating IV Fluids
IV push medications
Establish IV access
Administer blood products
Administer high risk medications (such as heparin, chemo)
Titrate medications
Making adjustments to medication dosage per an established protocol to obtain a desired therapeutic outcome
What is titrate?
What would affect a patient's ability to sign for informed consent?
Medications that alter thought processes/consciousness (sedatives, hypnotics)
Where does a patient transfer to after surgery?
Post-Anesthesia Care Unit (PACU)
What are some postoperative complications?
Delayed return of peristalsis
Wound dehiscence or evisceration
Infection
Fluid and electrolyte imbalances
Deep vein thrombosis
What tasks are appropriate to delegate to UAP?
Assisting with ADLs (eating, bathing, toileting, ambulating)
Perform routine data collection that does not require assessment or critical thinking (vital signs, weight, height, measuring I/Os)
Surgery performed to alleviate symptoms, reduce pain, or improve the client’s comfort without curing the disease.
What is palliative surgery?
What information should be gathered prior to surgery from the patient?
Comprehensive medication history
Medical history, esp cardiac and pulmonary conditions
Surgical history
Allergies
History of malignant hyperthermia
What are risks associated with general anesthesia?
Atelectasis
Overdose
Hypoventilation
What is dehiscence? What is evisceration? What nursing interventions are appropriate for these?
Dehiscence: the separation of surgical wound edges, exposing underlying tissues
Evisceration: protrusion of internal organs through a dehisced surgical incision site
Notify the provider immediately; cover wound with sterile nonadherent or saline dressing; instruct pt to limit movement and avoid coughing to limit wound stress
What tasks are appropriate to delegate to LPNs?
Assist with existing care plans
Reinforce teaching initiated by RN
Administer medications that are not high risk
Administer enteral feeding
Perform routine dressing changes
A state where the client remains conscious but deeply relaxed and pain-free; also known as “moderate sedation” or “twilight anesthesia.”
What is conscious sedation?