Pre-Op Care
What do you need to send with the patient to the OR?
-pre-op checklist, informed consent, lab/diagnostic reports or access to these
What should the nurse check for in the OR when setting up the patient?
Allergies (including latex)
informed consent completed
labs/diagnostic studies
completed records for health history/physical exam and pre-op checklist
What score should the patient have on the Aldrete scoring system to be considered "recovered"
7-10.
What does the nurse look at? activity, respirations, circulation, consciousness, 02 saturation
what is a common opioid medication given after surgery?
morphine (common)
hydromorphone, fentanyl, hydrocodone. Transition from IV to PO when patient can tolerate
What is rehabilitation nursing?
a specialty area of practice that focuses on returning patients to optimal functionality through a holistic approach to care that is based on scientific evidence
p 36 Hinkle et al.
Name at least two things that are of significant focus for the Joint Commission and Centers for Medicare/Medicaid in the surgical patient?
VTE prevention
surgical site infection prevention
wrong site surgery prevention
p 399 Hinkle
How can you administer general anesthesia?
IV, Inhaled or both
What is the priority for PACU nursing care?
ABC's first!
monitor for bleeding, return of sensation/motion, normalization of vital signs, assessment of surgical site, etc.
What medication do you administer when you need to reverse an opioid's effects?
Narcan
What is one of the most frequently used tools to assess the patient's level of independence?
Functional Independence Measure (FIM)
(Measures 18 self-care items)
p 37 Hinkle
What would be some teaching you would provide as the pre-op nurse to the patient?
what to expect, pain management, incentive spirometry use, deep breathing/coughing, ambulation importance, etc.
What is anesthesia awareness?
p 430-431 Hinkle
What can come up due to irritation of the phrenic nerve from surgery?
Hiccups---treated with chlorpromazine
How can heparin be administered?
VTE prophylaxis---subcutaneously
When you have an existing issue---IV
What are Activities of Daily Living?
ADLS; self care activities that the patient must accomplish each day to meet personal needs. Ex: bathing/grooming/eating/toileting/etc
p 37 Hinkle
Which population of people typically undergo surgery?
Geriatric population.
1/3 of people are 65 or older. Many considerations take place for the older person.
What are risk factors for PONV?
female, age less than 50, history of PONV, opioid administration
After NPO status, what does the patient normally transition into diet-wise?
clear liquids, then advances as tolerated
When is dantrolene sodium used?
For malignant hyperthermia
What are Instrumental Activities of Daily Living?
complex skills needed for independent living.
Ex: meal preparation, grocery shopping, financial and medicine management, etc.
Hinkle p 37
Do you shave the skin prior to surgery?
No---you clip hair as necessary. Shaving can cause infection.
What is malignant hyperthermia?
rare and inherited muscle disorder that is chemically induced by inhaled anesthetic agents and muscle relaxants
Tell me more about it----p 432 Hinkle
What can be used to help safeguard against dehiscence?
abdominal binder
p 457 Hinkle
What medication may the nursing team administer first-line for a low pain score?
A salicylate, typically acetaminophen
How do you prevent deformities and contractures?
maintaining correct body alignment and positioning, use of splints, use of exercises, nursing assessment, etc.
Hinkle p 41 (make sure you know the range of motion terminology)