Pre-Operative process
Name the Pre-op Prep patients do at home prior to surgery
Shower the night before. Towel dry completely, wait two hours. Use chx wipes from the neck down, as well as arms and legs on the front and back of the body avoiding the face, under arms and groin area.
Have nothing to eat after midnight the night before the surgery.
Take your carb drink 2 hours before your arrival time. (1/2 if you are diabetic)
you are allowed black coffee, tea without sugar or dairy, clear chicken broth, apple juice (if not diabetic) and water in the morning but the last thing you drink is the carbohydrate drink provided.
What are two causes of Cardiac arrest in Children and infants
Respiratory failure or shock
(hypoxemia or hypovolemia)
In what is situation should bradycardia be treated?
when the patient is symptomatic with hypotension and change of level of consciousness
BEFAST acronym stands for
Sudden loss of balance, coordination, dizziness, or stumbling while walking.
Sudden blurred, double or loss of vision in one or both eyes
Facial droop, numbness on one side of the face
Arm numbness or weakness
slurred, garbled or difficulty speaking
time to call 911
Why is a Healthy Work environment so important?
HWE are associated with improved Nurse satisfaction & retention as well as positive patient outcomes.
Unhealthy work environments have the opposite affect an contribute to stress and poor patient outcomes
When preforming pre-op calls the nurse must remind the patient that they must have a ____ ____in order to be discharged
Ride home with a responsible adult
An altered mental state, weak pulse, pale or blue skin are signs of......
What are the signs of poor circulation or poor perfusion?
If a patient tells you they are prone to fainting with lab draws and iv needle insertions, what are some good ways to prevent a vasovagal reaction?
position the bed flat
raise legs
warm extremity for maximum success for one time iv insertion
have IV fluids ready on a pump or pressure bag in anticipation of need of a fluid bolus if necessary.
what is the extension to reach the HBS during a stroke code to notify them of a positive BEFAST
extension 1947
Assess
Ask
Act
Affirm
What are the 4 A's to Rise above Moral Distress
list things needed to prep the pre-op bay the day before surgery for a patient who has obesity, immobility and need of Lyko-lift assistance
weigh bed
hoover matt
lyko-lift sling (ensure we have one and reserve it or go to ICU and get one)
(If DBS patient Bath basin with fluffs, alcohol, Betadine, 2 towels, 2 dry flow pads 3 clipper heads and clipper)
30:2 changes to 15:2 when......
you change from 1 rescuer to 2 when performing child or infant BLS?
Where is the emergency cricothyroidotomy kit for airway emergencies kept.
In anesthesia's work room in the difficult airway cart
A Change in your patients condition has prompted you to call the HBS for a positive BEFAST. what will the RN also check at the Bedside for a quick result to be reported.
Finger stick blood Glucose
Identify your source of stress: is it Personal or environmental
determine the severity of your stress
contemplate your readiness to act
Make an action plan
The Assessment step in the 4 A's of addressing moral distress
name some categories of Medications that have to stop before surgery:
Vitamin and herbal suppliments
Diabetic medicines the day of surgery
anticoagulants
GPL-1
What is the most common medication used for premedication in children in pre-op & what is the dose?
Oral Midazolam 0.5mg-1.0 mg/kg.
During your pre-op interview your patient tells you he was nauseated, sweaty and felt pressure in his chest after his carbohydrate drink but then it went away.
You see on the monitor V-tach and then your patient is suddenly unresponsive and pulseless
What are the next actions you expect to implement
Begin CPR while you simultaneously call for help and cart w Defibrillator
HBS authorizes you to initiate "stroke Alert Early" at extension 3333 and orders stroke/TIA evaluation order-set. List what happens next
1. Tele-stroke MD is contacted to eval via facetime. If unavailable on-call Neurologist is to be contacted by the operator,
2. Patient will be taken to CT scan
clear courteous closed loop communication
Teamwork as a whole department
Checking with our team mates to see if they need help
Asking for help
being proactive to ensure tasks are done to prep the unit for the next day
recognizing the value each member of the department brings to the team
Assessing what we can change and what we cannot
engage in team building exercises
Things we can do to facilitate a healthy work envirorment
What patients should bypass Pre-op and go straight to the OR
1. Covid positive in active isolation
2. Emergent need for surgery and transfusions to stabilize patients cardiovascular status where time is eminent.
3. When patient is coming from the ICU.
What should be available at every bedside in case of an airway emergency
Ambu bag w appropriate fitting mask and suction
A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered?
Adenosine 6mg
What are the Data collection points to document in a stroke center for stroke patients that assess how quickly the stroke was assessed and treated?
Last known well time
time of symptoms to assessment
assessment to CT scan
&
time from reading of CT scan to Intervention
because time is Penumbra!!!
Effective decision making. Being committed to partner in making policy. Directing and evaluating clinical care and leading organizational operations.
Appropriate staffing Matching patients needs w Nurse competencies
Meaningful Recognition for the value each person brings to the organization
Ensure Skilled communication which is as important as Nursing skills
Ensuring True collaboration within the department
Authentic Leadership Fully embrace the imperativeness of a healthy work environment. Authentically live it and engage others in it achievement
Are AACN's six essential standards that provide evidence based guidelines for a Successful HWE