Perioperative Nursing Chapter 5: The 3 Phases of Care
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Questions and Answers

When does the post-anesthesia care phase end?

  • When the patient leaves the hospital
  • When the patient wakes up from anesthesia
  • When the patient is discharged from all phases of post-operative care (correct)
  • When the patient is transferred to the ICU

    • What is the primary goal of maintaining a patent airway in post-anesthesia care?

  • To ensure the patient's breathing is stable (correct)
  • To prevent pain
  • To monitor the patient's heart rate
  • To prevent nausea and vomiting

    • What is a potential complication that can occur during post-anesthesia care?

  • Anemia
  • Hypertension
  • Diabetes
  • Hypothermia (correct)

    • What is a rare hereditary disorder that can occur during post-anesthesia care?

    <p>Malignant Hyperthermia</p> Signup and view all the answers

    What is the primary goal of nursing management during post-anesthesia care?

    <p>To provide comfort and relief to the patient</p> Signup and view all the answers

    What is a common symptom of Malignant Hyperthermia?

    <p>Rapid heart rate</p> Signup and view all the answers

    What is the first step in the pre-operative phase of perioperative care?

    <p>Informed consent</p> Signup and view all the answers

    What is the primary goal of informed consent?

    <p>To ensure the patient is aware of the risks and benefits of the surgery</p> Signup and view all the answers

    What is included in the health assessment during the pre-operative phase?

    <p>Health history, physical exam, and radiologic studies</p> Signup and view all the answers

    What is the primary focus of the intraoperative phase of perioperative care?

    <p>Maintaining aseptic techniques</p> Signup and view all the answers

    What is the purpose of the 'TIME OUT' procedure in the intraoperative phase?

    <p>To verify the patient's identity and surgical site</p> Signup and view all the answers

    What is the goal of conscious sedation during a surgical procedure?

    <p>To provide moderate sedation and analgesia</p> Signup and view all the answers

    What is the primary difference between general anesthesia and conscious sedation?

    <p>The level of consciousness during the procedure</p> Signup and view all the answers

    When does the post-operative phase of perioperative care begin?

    <p>When the patient is transferred to the PACU</p> Signup and view all the answers

    What is a key consideration for patients who are obese during the perioperative period?

    <p>Increased risk of infection</p> Signup and view all the answers

    What is the primary goal of the National Patient Safety Goals?

    <p>To prevent patient safety risks</p> Signup and view all the answers

    What type of wound healing results in a clean incision, good approximation of tissue, and minimal scar?

    <p>Healing by First Intention</p> Signup and view all the answers

    What type of wound healing results in a thick, poorly epithelialized scar?

    <p>Healing by Second Intention</p> Signup and view all the answers

    What is a common cause of postoperative delirium?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is NOT a risk factor for postoperative delirium?

    <p>Age less than 60 years</p> Signup and view all the answers

    What type of wound healing is characterized by delayed healing, deep wounds that couldn't be sutured, and infection?

    <p>Healing by Third Intention</p> Signup and view all the answers

    Which of the following is a risk factor for postoperative delirium?

    <p>Polypharmacy</p> Signup and view all the answers

    What is the recommended treatment for hypermetabolic state?

    <p>ICE, ICE, ICE, and dantrolene</p> Signup and view all the answers

    What is a risk factor for surgical complications?

    <p>Hypovolemia</p> Signup and view all the answers

    What is a discharge criterion from PACU?

    <p>Patient's pulmonary function is uncomplicated</p> Signup and view all the answers

    What is a nursing diagnosis related to surgery?

    <p>Risk for ineffective airway clearance</p> Signup and view all the answers

    What is a phase of healing for skin wounds?

    <p>Inflammatory phase</p> Signup and view all the answers

    What is wound dehiscence?

    <p>Disruption of the surgical wound/incision</p> Signup and view all the answers

    What is the ideal type of wound healing?

    <p>First intention</p> Signup and view all the answers

    What is a nursing intervention for promoting wound healing?

    <p>Managing potential complications</p> Signup and view all the answers

    What is a risk factor for surgical complications in patients with pulmonary disease?

    <p>All of the above</p> Signup and view all the answers

    What is a nursing intervention for promoting cardiac output?

    <p>Encouraging activity</p> Signup and view all the answers

    What is the primary focus of nursing management during post-anesthesia care?

    <p>Monitoring and managing adverse effects</p> Signup and view all the answers

    What is a common complication that may occur during post-anesthesia care?

    <p>Nausea and Vomiting</p> Signup and view all the answers

    What is a rare hereditary disorder that can occur during post-anesthesia care?

    <p>Malignant Hyperthermia</p> Signup and view all the answers

    What is a key aspect of assessing the patient during post-anesthesia care?

    <p>Monitoring vital signs</p> Signup and view all the answers

    What is a potential consequence of not maintaining a patent airway during post-anesthesia care?

    <p>Hypoxia</p> Signup and view all the answers

    What is a key aspect of preparing the patient for discharge from the PACU?

    <p>Ensuring stable vital signs and absence of complications</p> Signup and view all the answers

    What is the primary treatment for hypermetabolic state?

    <p>ICE, ICE, ICE and dantrolene</p> Signup and view all the answers

    Which of the following is a risk factor for surgical complications?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of nursing management during post-anesthesia care?

    <p>Monitoring vital signs and preventing complications</p> Signup and view all the answers

    What is the primary difference between general anesthesia and conscious sedation?

    <p>Level of consciousness and pain management</p> Signup and view all the answers

    What is the primary goal of conscious sedation during a surgical procedure?

    <p>Reducing anxiety and promoting relaxation</p> Signup and view all the answers

    What is a common symptom of Malignant Hyperthermia?

    <p>Muscle rigidity and hyperthermia</p> Signup and view all the answers

    What is a discharge criterion from PACU?

    <p>All of the above</p> Signup and view all the answers

    What is a nursing diagnosis related to surgery?

    <p>All of the above</p> Signup and view all the answers

    What is a phase of healing for skin wounds?

    <p>All of the above</p> Signup and view all the answers

    What is wound dehiscence?

    <p>Disruption of the surgical wound/incision</p> Signup and view all the answers

    What is the primary responsibility of the circulating nurse during the intraoperative phase?

    <p>To maintain aseptic techniques and ensure proper functioning equipment</p> Signup and view all the answers

    What is the primary goal of moderate sedation/analgesia during a surgical procedure?

    <p>To decrease anxiety and pain during the procedure</p> Signup and view all the answers

    What is the primary difference between general anesthesia and regional anesthesia?

    <p>The site of administration</p> Signup and view all the answers

    What is the primary role of the anesthesia provider during the intraoperative phase?

    <p>To administer anesthesia to the patient</p> Signup and view all the answers

    What is the primary goal of the post-operative phase of perioperative care?

    <p>To promote recovery and prevent complications</p> Signup and view all the answers

    What is the primary role of the RN First Assistant during the intraoperative phase?

    <p>To assist the surgeon with the surgical procedure</p> Signup and view all the answers

    What is the primary type of anesthesia used for surgical procedures that require a high level of CNS depression?

    <p>General anesthesia</p> Signup and view all the answers

    What is the primary consideration for patients who are obese during the perioperative period?

    <p>Increased risk of surgical complications</p> Signup and view all the answers

    What is the primary goal of the National Patient Safety Goals during the perioperative period?

    <p>To ensure patient safety and prevent errors</p> Signup and view all the answers

    What is the primary method of administering anesthesia during a surgical procedure?

    <p>Inhaled</p> Signup and view all the answers

    Study Notes

    Phases of Perioperative Care

    • Preoperative phase: begins with decision to have surgery, lasts until patient is transferred to operating room table • Includes: pre-admission testing, admission to surgical unit
    • Intraoperative phase: extends from admission to operating room to transfer to PACU • Includes: maintenance of safety, psychological support
    • Postoperative phase: starts with admission to PACU, ends when patient is discharged from all phases of postoperative care • Includes: transfer to PACU, post-anesthesia care unit recovery area, hospital room, home/clinic/rehab

    Surgical Classifications

    • Patients who are obese: increase risk and severity of complications, increase susceptibility to infection, increase technical and mechanical problems
    • Patients with disabilities: need for assistive devices, body positioning, problems with respiratory problems

    Gerontologic Considerations

    • Informed consent: ensure patient/patient's representative is provided with information necessary to make an informed decision
    • Health assessment: health history, physical exam, radiologic/laboratory studies
    • Nutritional and fluid status, drug or alcohol use, respiratory status, cardiovascular status, hepatic and kidney status, endocrine function, immune function, medication use, psychosocial factors, spiritual and cultural beliefs, presence of genetic disorders

    Preoperative Nursing Management

    • Provide preoperative teaching: timing and technique, deep breathing and coughing, use of incentive spirometer, promote mobility, pain management, NPO after midnight
    • Special preparations: bowel, skin, nutrition, and fluids

    Intraoperative Nursing

    • Patient identification and surgical site confirmation
    • Maintenance of patient safety
    • Maintaining aseptic techniques
    • Ensuring proper functioning equipment
    • Providing surgeon with instruments and supplies
    • Documentation
    • Assist in positioning patient on OR table
    • "TIME OUT"

    Postoperative Nursing

    • Patient identification and surgical site confirmation
    • Maintaining patient's airway
    • Monitoring vital signs
    • Assessing for anesthesia effects
    • Assessing for complications
    • Providing comfort and relief
    • Monitoring for potential complications: nausea and vomiting, hypoxia and other respiratory complications, hemorrhaging, hypothermia, malignant hyperthermia

    Complications and Risks

    • Malignant hyperthermia: rare hereditary disorder, occurs more often in males, symptoms include: dangerously high body temperature, rigid muscles or spasms, rapid heart rate, acidosis
    • Risk factors for surgical complications: hypovolemia, dehydration or electrolyte imbalance, nutritional deficits, extremes of age, extremes of weight, infection and sepsis, toxic conditions, immunologic abnormalities, pregnancy, pulmonary disease, renal or urinary tract disease, cardiovascular disease, cerebrovascular disease, endocrine dysfunction, hepatic disease, pre-existing mental or physical disability

    Phases of Perioperative Care

    • Preoperative Phase: begins with decision to have surgery, lasts until patient is transferred to operating room table
      • Includes pre-admission testing, admission to surgical unit
    • Intraoperative Phase: extends from admission to operating room to transfer to PACU
      • Includes maintenance of safety, psychological support
    • Postoperative Phase: starts with admission to PACU, ends when patient is discharged from all phases of postoperative care
      • Includes transfer to post-anesthesia care unit, hospital room, home/clinic/rehab

    Surgical Classifications and Special Populations

    • Patients who are Obese: increase risk and severity of complications, susceptibility to infection, technical and mechanical problems
    • Patients with Disabilities: need for assistive devices, body positioning, respiratory problems
    • Gerontologic Considerations: no specific details provided

    Preoperative Phase

    • Informed Consent: ensure patient/patient’s representative is provided with necessary information to make informed decision
    • Health Assessment: includes health history, physical exam, radiologic/laboratory studies
    • Preoperative Health Assessment: evaluate nutritional and fluid status, drug/alcohol use, respiratory status, cardiovascular status, etc.

    Preoperative Nursing Management

    • Preoperative Teaching: provide patient education on timing and technique, deep breathing and coughing, use of incentive spirometer, promote mobility, pain management, NPO after midnight
    • Special Preparations: bowel, skin, nutrition, and fluid preparations

    Immediate Preoperative Care

    • Patient Identification: confirm patient identity
    • Patient Preparation: patient changes into hospital gown, removes jewelry/dentures/glasses, voids before OR
    • IV Placement: place IV line for medication administration
    • Vital Signs: monitor vital signs before transportation to OR
    • Transportation to OR: safely transport patient to OR

    Intraoperative Nursing

    • Nursing Care: maintain patient safety, aseptic techniques, ensure proper equipment functioning, provide surgeon with instruments, document care
    • Positioning on Operating Table: assist with positioning patient on OR table
    • “TIME OUT”: perform surgical timeout to confirm patient identity, surgical site, and procedure

    Anesthesia and Surgical Experience

    • Types of Anesthesia: general, regional, moderate, monitored anesthesia care, local
    • Anesthesia Provider: monitors vital signs, oxygen saturation, tidal volume, blood gases, blood pH, body temperature, EKG
    • Conscious Sedation: moderate sedation/analgesia, patient is in pharmacologically controlled state of limited or minimally depressed consciousness
    • Spinal and Epidural Anesthesia: types of regional anesthesia
    • General Anesthesia: anesthetic-induced depression of CNS, patient is not arousable, loses protective reflexes, unable to breathe on own

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    Description

    This quiz covers the three phases of perioperative care, including preoperative, intraoperative, and postoperative care, and their respective activities.

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