Exam 16 - Preoperative and Perioperative Nursing Terms

Preoperative and Perioperative Nursing Definitions

• Ambulatory: Outpatient surgery; patient enters, has surgery, and leaves the same day. (Examples: breast biopsy, cataract extraction)
• Same-day admit: Patient admitted to hospital, surgery on same day, stays for recovery. (Example: cholecystectomy)
• Inpatient: Patient admitted, surgery (possibly not on admission day), stays for recovery. (Examples: amputation, heart transplant)
• Major: Extensive reconstruction; high risk. (Examples: coronary artery bypass, colon resection)
• Minor: Minimal alteration; low risk. (Examples: cataract extraction, skin graft, tooth extraction)
• Elective: Performed at patient's choice. (Example: bunionectomy)
• Urgent: Necessary for patient health. (Examples: cancerous tumor removal, gallbladder removal for stones)
• Emergent: Immediate; life-saving or function-preserving. (Examples: perforated appendix removal, traumatic amputation repair)
• Diagnostic: Surgical exploration to confirm diagnosis. (Examples: exploratory laparotomy, breast mass biopsy)
• Ablative: Removal of diseased body part. (Examples: amputation, appendix removal, cholecystectomy)
• Palliative: Relieves disease symptoms; not curative. (Examples: colostomy, necrotic tissue debridement)
• Reconstructive: Restores function or appearance. (Examples: fracture fixation, scar revision, breast reconstruction)
• Curative: Cures the problem.
• Preventive: Prevents problems.
• Transplant: Replaces malfunctioning organs. (Examples: cornea, heart, joints, kidney)
• Constructive: Restores function lost due to a congenital anomaly. (Examples: cleft palate repair, atrial-septal defect closure)
• Cosmetic: Alters appearance. (Example: rhinoplasty)
• Common Surgical Settings: (Note: no specific settings listed).

Perioperative Nursing

• Perioperative period: Preoperative (before surgery), intraoperative (during surgery), and postoperative (after surgery) phases. Nurses provide continuous care using the nursing process.
• Delegation considerations: Nurses are responsible for skilled assessment. Unlicensed assistive personnel (UAP) may assist with vital signs, height/weight, and some post-op exercises, but not skilled assessments.
• Preoperative teaching: Done by the nurse; UAP may assist with post-op exercises and reviewing precautions.
• Coordination: Nurse coordinates pre-op preparation; UAP may assist with enemas, vital signs, stockings, and removing clothing/jewelry.
• Sterile procedures: Surgical technologists or skilled nurses perform sterile technique.
• Postoperative care: Initiating and managing post-op care requires critical thinking and nursing knowledge; UAP can assist with vital signs, comfort measures, and basic hygiene tasks.

Influencing Factors in Perioperative Patients

• Age: Young/old patients tolerate major procedures less well than middle-aged adults; older patients have higher morbidity/mortality; slower recovery; higher risk for complications (aspiration, atelectasis, pneumonia, embolus, infection).

• Physical condition: Assess for allergies, bleeding/clotting disorders, cortisone/steroid use, diabetes, emboli risk, immune status using ABCDEF mnemonic.

• Nutritional Factors: Diet history needed to understand nutritional intake; protein for tissue repair; carbohydrates/fats for energy.

• Psychosocial needs: Anxiety, financial concerns, mobility, living situation, death, anesthesia side effects, body image, fear of cancer detection.

• Patient Teaching: Preoperative tests, sequence of events, equipment, transfers, monitoring, mobility, IS, IVs, pain management.

• Socioeconomic and cultural needs: Cultural sensitivity; use interpreters, adjust for sensitivities of different cultures (eye contact, communication, etc).

Medications

• Polypharmacy: Common, especially in older adults; increased risk of adverse drug interactions.
• Herbal remedies: Important to inquire about herbal use as alternative or complementary therapy.
• Medication withholding: Certain medications may be stopped before surgery; nurses need medication knowledge.
• Medications taken on the day of surgery: Antiseizure and cardiac medications may be taken with water the morning before surgery.

Preoperative Assessment and Data Collection

• Thorough health assessment: Allergies, past surgeries, infection, and disease history.
• Medication list: Prescription, over-the-counter, vitamins, minerals, and herbal supplements crucial.
• Chemical, alcohol, and recreational substance use: Assists in medication selection and post-op care planning.
• Vital signs, height, and weight: Baselines for post-op comparisons; guide medication dosing.

Preoperative Teaching

• Reduce anxiety: Educate about the procedures, equipment, transfers, etc.
• Verify understanding: Use open-ended questions; accommodate reading abilities.
• Use interpreters: Ensure patients who do not understand English receive clear information.
• Involve family: If appropriate, include family members in teaching sessions.

Preoperative Preparations

• Laboratory tests and Diagnostic imaging: Complete blood count, blood chemistry, hepatic, cardiac, and renal functions, urinalysis, chest X-ray.
• Informed consent: Obtain consent; avoid if patient is disoriented, unconscious, etc; follow facility protocols. Emergency situations may require alternative consent.
• GI preparation: NPO (nothing by mouth) typically from midnight. Recent recommendations for clear liquids have been reviewed or updated. Anesthesia relaxes the bowel; bowel cleansing may be used (N/V). Oral care is possible, with fluid avoidance.
• Skin preparation: Hair removal at surgical site, as appropriate. Surgical area cleaned with antiseptic.
• Respiratory preparation: Incentive spirometry for atelectasis and pneumonia prevention. Coughing and splinting techniques. Early ambulation to improve respiratory function.
• Cardiovascular considerations: Leg exercises, early ambulation; anti-embolism stockings, sequential compression devices (SCD). Postoperative cardiovascular health is an important element of rehabilitation.
• Genitourinary considerations: Assess for urinary retention.
• Surgical wounds/tubes: Explain types of closures; monitor any drains, tubes, etc.
• Pain management: Educate about pain relief methods; non-pharmacologic, analgesics, PCA pumps.
• Preoperative medications: Reduces anxiety, and amount of anesthetic. Side effects, as well as safety measures, should be discussed.
• Latex allergy: Screen for latex allergies; prevent latex exposure during surgery, if possible.

Anesthesia

• Four categories: General, regional, local, conscious sedation.
• General anesthesia: Produces unconsciousness; used for major procedures. Stages include induction, maintenance, and emergence.
• Regional anesthesia: Loss of sensation in a specific area; no loss of consciousness. Includes epidural, nerve block, and spinal anesthesia.
• Local anesthesia: Loss of sensation at the site (e.g., biopsy, wisdom teeth).
• Conscious sedation: Depressed level of consciousness; used for procedures that do not require complete anesthesia. Requires careful monitoring and skilled nursing.

Preoperative Checklist and Transport to OR

• Verification process: Critical to ensure correct patient, procedure, and site.

• Preoperative checklist: Completed prior to pre-op medication and surgery. This includes patient identification, allergy bands, surgical site marking, removal of prosthetics, skin preparation completed, gowns, NPO time, lab results, current xrays and scans, and pre-op vital signs.

• Transport to OR: Personnel verification, patient identification checks, transport method considerations.

Post-op preparations

• Preparing for the Postoperative Patient:* Bedding, gowns, emesis basin, pillows for positioning. necessary equipment-IV pole, IV pump, oxygen equipment, PCA pump, sphygmomanometer

Test your knowledge of key definitions in preoperative and perioperative nursing. This quiz covers various types of surgery classifications, such as elective, urgent, and emergent procedures. Enhance your understanding of patient care practices in surgical settings.