peri-op nursing I
what is the goal of intra-operative nursing care
keep patient injury free and infection free; SAFETY
which of these is not a pre-op protocol
1. turning schedules
2. NPO diet
3. informed consent
4. skin preparation
That is used post-op to prevent complications (DVT and skin breakdown)
The rest are pre-op protocols to prepare the patient for surgery
name 2 reasons why infants need extreme caution with surgery
extra points for a 3rd reason
low blood volume makes them more likely to fatally hemorrhage, cannot thermoregulate or deal with cold well, skin and mucous membranes are thin and easily traumatized, everything (doses, equipment, instruments) need to be adjusted for size
what is the first thing you do with a minor burn patient?
remove the patient from the source of the burn
What type of pressure injury is this?
The nurse in the long-term care facility observes that a client has developed a sacral pressure wound, which is very red and surrounded by blisters. Which stage of pressure injury does this client present?
Stage II
Skin is not intact by the blisters. No subcutaneous tissue or bone/muscle/fascia is present
What is the last step or final verification that all healthcare members in the operating room have the correct information before surgery?
pre-procedural pause or the "Time Out"
True or False
if the HCP hasn't already gotten written informed consent from the patient, the nurse may do so
False
The nurse can witness the patient sign a consent form or be informed by the HCP, but they cannot obtain consent themselves
The nurse needs to apply a dressing of a highly absorbent nature. Which type of dressing should the nurse use for this client?
hint: 1 of the 3 in the slides
gauze
what is the best environment for a wound to heal in?
consistently moist environments
- products used to add moisture if dry or absorb excessive drainage without making it dry
True or False?
Dermatitis is a nonmalignant, chronic skin disorder that is characterized by increased skin production rate and patches of thick red skin with silvery scales
False
Dermatitis (aka eczema) is an inflammatory response of the skin to irritants, allergy, or trauma characterized by erythema, pruritis (itchy), and skin lesions
Psoriasis is what is being described above
what is the difference between the scrub nurse and circulating nurse?
extra points: what are they both accountable for?
scrub nurse is STERILE and provides the surgeon with instruments they need and try to anticipate their needs
circulating nurse is not sterile, manages patient care, make sure their rights/safety are being protected, monitor aseptic practices and coordinates activites
both responsible for instrument and sponge count at the end
Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?
antiembolism stockings or SCD/foot pumps
true or false
The surgeon, not the CRNA or anesthesiologist, is responsible for administering local anesthetics
True!
most wounds heal by which type of process?
hint: 2 words, second word starts with letter I
secondary intention
Most wounds heal by secondary intention, which is where edges cannot be approximates so granulation tissue is built and fills wound to heal
when do you use heat and cold therapy?
extra points: describe at least 1 thing heat and cold does to injuries
- controls hemorrhage, edema, pain, swelling, and vasconstricts
heat used after the first 24 hours
- vasodilates, increases blood/oxygen/nutrient/antibiotic/leukocyte supply to wound, promotes muscular relaxation, relieves spasms
why is there pre-op testing for
1. CBC
2. urinalysis
3. ECG
1. notice changes in WBC (infection), platelets (risk for hemorrhage), and RBCs (anemia)
2. BUN, creatinine, kidney function to make sure the pt can handle anesthesia (many are excreted in kidney)
3. identify any cardiac risk before surgery
An otherwise healthy surgical client has developed sharply increased muscle tone and rapid increase in heart rate and core body temperature. The operating room team should proceed with assessments and interventions that address what health problem?
extra points: what should be used to treat this
malignant hyperthermia
should be treated STAT with datrolene sodium
match the type of debridement to the description
types: sharp, mechanical, autolytic, enzymatic
1. removes debris and necrotic tissue by using the body's cells and fluid
2. use of surgical objects in the OR or at the bedside to remove tissue
3. use of chemical products to breakdown necrotic tissue
4. use of wet-to-dry dressings or other nonselective use of force that removes bad tissues
1. autolytic
2. sharp
3. enzymatic
4. mechanical
types: abrasion, puncture, laceration, contusion
1. closed wound; bleeding in underlying tissues from a blunt blow; major bruising
2. intentional or unintentional penetrating trauma by a sharp/pointed object that penetrates the skin and tissues
3. cut in skin with either smooth or jagged wound edges; can be shallow or deep; high infection risk
4. wound involving friction; superficial; shearing of top layers of skin
1. contusion
2. puncture
3. laceration
4. abrasion
match the complication with the description
evisceration, dehiscence, infection, hematoma, hemorrhage
1. pain, fever, redness, edema, heat, purulent damage
2. swelling, vital signs change, hypovolemia, increased HR
3. bowel or organ pops out from wound, must cover with a moist dressing
4. swelling, bruising, blood-filled cyst that may need drainage
5. wound edges separate due to swelling, obesity, pressure, poor nutrition, inadequate suturing
1. infection
2. hemorrhage
3. evisceration
4. hematoma
5. dehiscence
What is the most commonly assessed postanesthesia recovery emergency?
respiratory obstruction or respiratory failure (atelectasis, pneumonia, hypoventilation due to anesthesia, etc)
match drug to description
drugs: propofol, isoflurane, midazolam, vecuronium
1. most widely used IV anesthetic, produces amnesia, euphoria, hypnosis, blocks perfection of pain but DOES NOT produce analgesia; 1 minute onset and 10 minute recovery after discontinued
2. benzodiazepine, used as a sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant; adjuvant med
3. muscle relaxant that prevents spasms and muscle stiffness; suspends nerve impulses and produce anything from weakness to complete paralysis; 3-5 minute onset
4. potent inhalation anesthetic; coherent in 15-30 minutes; adverse effect of airway irritation; amnesia, muscle relaxant, hypnosis
1. propofol
2. midazolam
3. vecuronium
4. isoflurane
DAILY TRIPLE
what are the 4 components of balanced anesthesia?
extra extra points: name a drug or class that does one of these things
1. amnesia or memory loss
2. analgesia (reduction or absence of pain)
3. hypnosis or unconsciousness
4. muscle relaxation or immobility
propofol, isoflurane, vecuronium, midazolam, fentanyl
match the wound healing steps to the time period when each happens
steps: proliferative, hemostasis, maturation, inflammation
1. immediately after
2. up to 3 days
3. 4-21 days
4. 3 wks - 6 mo
1. hemostasis
2. inflammatory phase
3. proliferative phase
4. maturation
name whether these injuries are acute or chronic?
extra points if you name whether its surgical or not
1. burn wounds
2. incision
3. dehisced wound
4. venous pressure ulcer
1. acute/nonsurgical
2. acute/surgical
3. chronic/surgical
4. chronic/nonsurgical