Perioperative Nursing
what does Preoperative phase begin and end?
1- begins with the decision to proceed with surgical intervention.
2- Ends with the transfer of the patient onto the operating room (OR) bed
why do you need to chart pain before and after medicating?
to make sure that the medication was effective
What do you think it might affect someone psychological readiness to have a surgery?
previous surgical experience on self or family member (can affect positively or negatively)
what is the most important thing to assess for the GI system?
when the patient last ate and/or drank
Can you delegate hair removal to anyone?
No ( you are responsible for it)
when does Intraoperative phase begin and end?
1- begins when the patient is transferred onto the OR bed
2- ends with admission to the post anesthesia care unit (PACU)
how would you know that a patient is allergic to latex latex?
Ask the patient if they are allergic to the following:
a)Balloons
b)Condoms
c)Bananas
d)Kiwi
e)Stone fruit (peaches, avocadoes)
What are some exercises they would have to do whether or not they have the SCDs on?
1- Quad sets
2- gluteal sets
Why do we care If the patient has any kidney problems?
that will be a concern because a lot of drugs are processed in the kidney
You have medicated your patient with an opioid and now they are requesting to go to the restroom; what should you do?
2-why should you have patient void before surgery?
1- Give them a urinal, or bed pan
2- void before surgery especially before medication because medications for example benzo will make patients unstable enough to go to the bathroom) and they will be a risk for fall
when does Postoperative phase begin and end?
1- begins with the admission to the PACU
2- ends with a follow-up evaluation in the clinical setting or home
Within how many hours should the History and physical exam be done?
What if it it not done within the timeframe?
1- within 72 hours
2- the doctor has to do what is called the update form
Who can sign the consent on behalf of the patient (impaired cognitively) ?
what would you do If the patient is cognitively impaired?
1- Legally power of attorney/conservator
2- you need to have their family present
To whom should you report problems affecting the cervical or lumbar spine?
¨Anesthesiologist: because that can affect patient airway management (head and neck are anesthesiologist’s domain
what is Pharmacodynamics?
what is pharmacokinetics?
1- what a drug does to the body
2- what the body does to the drug
Purposes of the surgery?
1.a diagnosis (a diagnostic procedure such as biopsy, exploratory laparotomy, or laparoscopy)
2.a cure (e.g., excision of a tumor or an inflamed appendix)
3.repair (e.g., multiple wound repair).
4.reconstructive or cosmetic (such as mammoplasty or a facelift)
5.palliative (to relieve pain without fixing the problem—such as debulking a tumor to achieve comfort, or removal of a dysfunctional gallbladder)
6.rehabilitative (e.g., total joint replacement surgery to correct crippling pain or progression of degenerative osteoarthritis).
what lab tests and studies are needed for the surgery?
1- urinalysis è need to be done whether the patient says it is possible or impossible è because anesthesia can harm the fetus
2- Chest x-ray è if the patient has any cardiac issues or pulmonary issues
3- Blood test: PT/INR (clotting factors), BUN & creatinine (for the kidney function), liver function, pulmonary function test
4- electrolytes: the most important one (Potassium)
How long should a smoker patient quit smoking prior to the surgery?
6 weeks
Can patients who are on steroids or hormones discontinue the medication abruptly or not and why?
What is the reason that patient who is NPO their sugar is high?
1- No, because it can lead to addisonian crisis
2- Surgery Stress
Can the surgeon ask the nurse to have the patient sign the consent form?
What about during medical emergency if no one is able to sign?
1- Yes, the nurse is having the patient sign the form but the patient is not giving the nurse the consent
2- 2 doctors agree that this is something that a reasonable person would consent to and they sign their own separate form (quality variance report)
what are the Surgical catagories and give examples of each?
1- Emergency: patient requires immediate attention and disorder maybe life threatening. Without delay, i.e: sever bleeding, bladder or intestinal obstruction, fractured skull, gunshot, stab wound, extensive burns, and (AAA)
2- Urgent: patient requires prompt attention. Within 24 to 30 hours, i.e: closed fractures, infected wounds, exploration/ irrigation, gallbladder
3- required: patient needs to have the surgery. Plan within weeks or months, i.e: prostatic hyperplasia, thyroid disorder, and cataract
4- elective: patient should have the surgery, failure to have the surgery not catastrophic, i.e: repair of scars, simple hernia, and vaginal repair
5- Optional: decision rests with patient. Personal preference, i.e cosmatic surgery (nose job)
what is the Pre-op check list that a nurse must check before transporting patient to the OR?
¨History and Physical (H&P) Exam on chart
¨Signed consent on chart
¨Pre-op tests, labs on chart
¨Preps done (skin, bowel)
¨Pt voided
¨Pre-op meds given
¨Side rails up
¨Charting completed
¨Baseline vitals
¨Consultation records
¨Nurse’s notes
Your patient has a productive cough of green sputum, who should you report this to? What tests might you see ordered?
1- The anesthesiologist because the airway is the anesthesiologist domain
a)Sputum culture
b)Chest x-ray
what can bowel prep do to the fluid and electrolyte ?
What is the evidence based practice for the NPO status?
What are the things that affect healing?
1- an electrolyte imbalance
2- Patients can have clear liquid up to 2 hours before the OR
3- a)Poor nutrition
b)Poor hydration
what are the Physician’s Responsibility?
1- Explain procedure
2- Answer any questions
3- Obtain informed consent
4- Mark site
5- Complete H&P or verification form