Perioperative Nursing Care Quiz

Perioperative Phases

• Preoperative, Intraoperative, and Postoperative phases of surgical care

Classification of Surgical Procedures

• Types of surgery classified based on purpose, degree of invasiveness, and urgency

Types of Anesthesia

• I. General Anesthesia: induces total unconsciousness
• II. Moderate Sedation/Analgesia: reduces anxiety and discomfort
• III. Regional Anesthesia: numbs a specific region of the body
  • I. Nerve Blocks
  • II. Spinal Anesthesia
  • III. Epidural Anesthesia
• IV. Topical & Local Anesthesia: numbs a small area of the body

Informed Consent and Advanced Directives

• Informed Consent: a legal document that protects patient, provider, and facility
• Advanced Directives: a legal document that outlines patient's wishes for medical care
  • Living Will
  • Durable Power of Attorney

Nursing Strategies in the Older Perioperative Patient

• Special considerations for older patients undergoing surgery

Nursing Process: Preoperative Care

• Preoperative nursing history and physical assessment to identify patient strengths and risk factors
• Identify medications and treatments that may affect surgical outcomes
• Determine teaching and psychosocial needs of patient and their support system
• Determine postsurgical support and referral needs for recovery
• Usual presurgical screening tests: Chest x-ray, ECG, CBC, electrolyte levels, and urinalysis

Preoperative Considerations for Outpatient Surgery

• Special considerations for outpatient surgery patients

Preoperative Health History

• Developmental level
• Medical and surgical history
• Medication history
• Nutritional status
• Substance use
• Activities of daily living and occupation
• Coping patterns and support systems
• Sociocultural needs

Surgical Risks of Rx Medications

• Anticoagulants: precipitate hemorrhage
• Diuretics: electrolyte imbalances and respiratory depression
• Tranquilizers: increase hypotensive effects of anesthetic agents
• Adrenal steroids: abrupt withdrawal may cause cardiovascular collapse
• Antibiotics in mycin group: respiratory paralysis when combined with certain muscle relaxants

Surgical Risks of OTC or Herbal Medications

• Aspirin & Gingko: bleeding
• Echinacea & Kava: liver damage
• Garlic supplements: lower BP
• Ginseng: raise BP, rapid HR
• Ephedra: raise BP, abnormal heart rhythms
• St. John's Wort: harder to recover from effects of anesthesia
• Valerian: harder to wake after anesthesia, abnormal heart rhythms

Focused Preoperative Physical Assessment

• Head-to-toe assessment to identify potential surgical risks

Preoperative Nursing Diagnoses

• Identify potential risks and complications

Preoperative Outcome Identification and Planning

• Verbalize physical and emotional readiness for surgery
• Demonstrate understanding of coughing, turning, deep-breathing, and leg exercises
• Verbalize expectations of postoperative pain management
• Maintain fluid intake and nutritional balance to meet healing needs

Preoperative Implementation and Evaluation

• Implement preoperative care plan
• Evaluate patient's readiness for surgery

Nursing Process: Intraoperative Care

• Patient identification/verification process
• Final verification just prior to beginning the procedure
• Patient assessment during procedure
• Nurse continually assesses patient and monitors supplies used to maintain safety

Intraoperative Nursing Diagnoses

• Identify potential risks and complications

Intraoperative Outcome Identification and Planning

• Remain free of neuromuscular injury
• Remain free from wrong-site, wrong-side, wrong-patient surgical procedure
• Maintain fluid and electrolyte balance
• Maintain skin integrity (other than for the incision)
• Have symmetric breathing patterns
• Be free of injury from burns, retained surgical items, and medication errors
• Remain free from surgical site infection
• Maintain normothermia

Intraoperative Implementation and Evaluation

• Positioning
• Draping
• Documenting patient assessment, item counts, vital signs, urine output, blood loss, pulse oximetry, body temperature, positioning, medications, dressings and drains, specimens, equipment used, and responses to care
• Transferring to the PACU
• Handoff: patient's care, procedure, tourniquet time, drains, medications used, presenting condition, and patient response
• Evaluation

Nursing Process: Postoperative Care

• Immediate postoperative assessment and care (every 10-15 minutes)
  • Respiratory status
  • Cardiovascular status
  • Central nervous system status
  • Fluid status
  • Wound status
  • Gastrointestinal status
  • Pain assessment
  • General condition

Ongoing Postoperative Assessment and Care

• Continue to assess and care for patient's needs

Postoperative Nursing Diagnoses

• Identify potential risks and complications

Postoperative Outcome Identification and Planning

• Carry out leg exercises
• Deep breathe and cough effectively
• Engage in early ambulation
• Verbalize decreasing levels of pain
• Regain and maintain a balanced intake and output
• Regain normal bowel and bladder elimination
• Exhibit a healing surgical incision
• Remain free of infection
• Verbalize any concerns about appearance of wound
• Verbalize and demonstrate wound self-care

Postoperative Implementation and Evaluation

• Preventing cardiovascular complications
• Preventing respiratory complications
• Preventing surgical site complications
• Promote a return to health
• Helping the patient cope
• Providing outpatient surgery postoperative care
• Evaluation