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Questions and Answers
What potential complication can occur with the sudden discontinuation of corticosteroids during the preoperative period?
Which medication can cause hypo or hyperglycemia during the intraoperative period?
Which special consideration applies to geriatric patients undergoing surgery?
What is a significant risk factor for bariatric patients during the perioperative period?
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Which of the following is NOT a part of patient education prior to surgery?
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What is the primary purpose of the universal time out procedure in the operating room?
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Which of the following is a characteristic of the semi-restricted zone in an operating room?
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Which type of anesthesia involves the patient being unconscious and their airway supported?
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What indicator is NOT typically associated with hypovolemic shock?
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In maintaining cardiovascular stability postoperatively, what should be continuously monitored?
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Which of the following is NOT part of maintaining asepsis in the operating room?
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Which complication is indicated by cool, moist skin and rapid, weak pulse post-surgery?
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What role does the anesthesiologist play in the operating room?
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What is a primary characteristic of unstable angina?
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What is a common outcome of left-sided heart failure if untreated?
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Which of the following is a characteristic of chronic heart failure?
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What are the primary symptoms of right-sided heart failure?
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What is one of the structural or functional causes of heart failure?
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Which of the following describes the relationship between heart failure and its management?
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Which statement about myocardial infarction (MI) types is accurate?
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What is the primary physiological effect of heart failure?
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Study Notes
Members of the Surgical Team
- Surgeon
- Anesthesiologist
- Registered Nurse
- Surgical Technician
- Certified Registered Nurse Anesthetist
- Other medical professionals
Preadmission Testing
- Initiates the nursing assessment process
- Begins prior to the patient arriving at the hospital
- Allows healthcare providers to identify potential risks or issues that may affect surgery
Preoperative Assessment
- Vital signs
- Medical history
- Surgical history
- Medication history
- Allergies
- Social history (smoking, alcohol, drug use)
- Family history
- Physical exam
Medications that Potentially Affect Surgical Experience
- Corticosteroids: Sudden discontinuation can lead to cardiovascular collapse
- Diuretics: Can cause respiratory depression, fluid volume deficit, and dysrhythmias
- Antipsychotics: Increase the risk of hypotension
- Opioids & Benzodiazepines: Abrupt discontinuation will lead to withdrawal symptoms
- Insulin: Can cause hypoglycemia or hyperglycemia intraoperatively
- Erythromycin: Can cause apnea and respiratory paralysis
- Anticoagulants: Increase the risk of bleeding
- Antiseizure medications: May require continued administration for seizure prevention
- Thyroid Medications: Metabolic collapse may occur without proper dosage
Special Considerations During the Perioperative Period:
- Geriatric patients: Often have multiple comorbidities, increased sensitivity to surgical medications, longer healing times, and higher risk of complications.
- Bariatric (Obese) patients: Increased risk of infections, surgical complications, longer healing times, and positioning challenges due to weight and body size
- Informed consent: Ensures the patient understands the procedure, risks, benefits, and alternatives. Requires a witness.
Patient Education
- Deep breathing and incentive spirometry
- Early mobility and active body movement
- Pain management
- Cognitive coping strategies
- Specific instructions for patients undergoing ambulatory surgery
Intermediate Preoperative Nursing Interventions:
- Patient teaching
- Preoperative medications
- Preoperative skin preparation
General Preoperative Nursing Interventions:
- Assessment of patient readiness
- Emotional support
- Dietary restrictions
- Elimination interventions
- Skin preparation
- Pre-operative medications
- Transportation to the operating room
Intraoperative:
- Roles in the OR: Circulating nurse, scrub nurse, surgeon, anesthesiologist
- Environment: Controlled temperature (cold and clean)
- OR Zones: Unrestricted (street clothes), semi-restricted, restricted (full OR garb)
- Asepsis: Sterilized equipment, prepackaged supplies, and sterile fields maintained
- OR Environment: Music, talking may or may not be permitted, teaching may occur
- Electrical Equipment Risks: Lasers and radiation
- Anesthesia: General anesthesia (loss of consciousness, airway supported or intubated) - includes inhalation and/or IV medications
- Know Surgical Positions
- Universal Time Out: A process to ensure correct patient, procedure, site, and implants
Asepsis Principles
- Sterile surfaces contact only sterile surfaces.
- Any non-sterile surface contaminated with non-sterile contact renders the item non-sterile.
- Sterile items become non-sterile if they remain exposed to the air for an extended period.
- Any object below the waist or table level is considered contaminated.
- Sterile persons must pass each other back to back.
- Sterile persons must keep a distance of one foot apart.
- Sterile persons may not speak in a way that causes air currents.
- Sterile persons must keep gowns and gloves within the sterile field.
- Any drape with tears or breaks is considered contaminated.
- Fluid flows in the direction of gravity.
Types of Anesthesia
- General
- Regional
- Local
- Monitored Anesthesia Care (MAC)
Surgical Positions
- Supine
- Prone
- Lateral
- Lithotomy
- Trendelenburg
Intraoperative Complications
- Hemorrhage
- Hypovolemia
- Shock
- Hypothermia
- Malignant hyperthermia
- Anaphylaxis
- Nausea and vomiting
- Pneumonia
Adverse Effects of Surgery and Anesthesia
- Pain
- Nausea and Vomiting
- Difficulty breathing
- Respiratory depression
- Bleeding
- Infection
- Wound complications
- Delayed wound healing
Postoperative
- Assessment of recovery from anesthesia: Monitor vital signs, airway, circulation, mental status, and pain.
- Pain management: Provide appropriate pain relief measures to ensure patient comfort and promote healing.
- Comfort management: Promote comfort by adjusting the patient's environment (temperature, lighting, noise) and using appropriate positioning techniques.
- Respiratory care: Encourage deep breathing, coughing, and incentive spirometry to prevent atelectasis and pneumonia.
- Gastrointestinal function: Observe for bowel sounds and encourage early ambulation to prevent bowel obstruction.
- Fluid balance: Monitor intake and output and provide appropriate I.V. fluids to prevent dehydration.
- Wound care: Assess the surgical incision site, manage drainage, and apply appropriate dressings to promote healing and prevent infection.
- Promote early mobility: Encourage patients to get out of bed as soon as possible to prevent complications such as pulmonary embolism, deep vein thrombosis, and constipation.
- Discharge planning: Ensure patients understand their discharge instructions, medications, and follow-up appointments.
Outpatient Surgery/Direct Discharge
- Discharge criteria: Patient must be alert, stable, and able to tolerate oral fluids, and demonstrate understanding of discharge instructions.
- Postoperative education: Review discharge instructions, medication schedule, risks of complications, and follow-up appointments.
Maintain Patent Airway
- Primary consideration: Necessary to maintain ventilation and oxygenation.
- Assess for airway obstruction, signs of respiratory distress.
- Provide supplemental oxygen as indicated.
- Maintain head of bed elevation as necessary.
Maintaining Cardiovascular Stability
- Monitor cardiovascular status, including vital signs, IV lines, potential hypotension, shock, hemorrhage, hypertension, and arrhythmias.
Indicators of Hypovolemic Shock/Hemorrhage
- Pallor (pale skin)
- Cool, moist skin
- Rapid respirations
- Cyanosis (bluish discoloration of the skin)
- Rapid, weak, thready pulse.
- Decreasing pulse pressure
- Low blood pressure
- Concentrated urine
Jackson Pratt (JP) Drain
- Assess color, consistency, and amount of drainage.
- Empty the drain as needed.
- Monitor for signs of infection.
Hemovac Drain
- Assess color, consistency, and amount of drainage.
- Empty the drain as needed.
- Monitor for signs of infection
Wound Complications
- Dehiscence (wound separation)
- Evisceration (protrusion of organs)
- Hematoma (collection of blood)
- Seromas (collection of fluid)
- Infections
Postoperative Complications
- Pulmonary: Pneumonia, atelectasis, pulmonary embolism
- Cardiovascular: Heart attack, stroke, arrhythmias, deep vein thrombosis,
- Gastrointestinal: Constipation, ileus, nausea and vomiting,
- Renal: Acute kidney injury, urinary tract infections,
- Neurological: Delirium, cognitive decline, stroke, seizures
- Wound: Infections, dehiscence, evisceration
Three Layers of the Heart Wall
- Epicardium: Outermost layer
- Myocardium: Middle layer (muscle layer)
- Endocardium: Innermost layer
EKG
- A recording of the electrical activity of the heart
- P wave: Atrial depolarization
- QRS complex: Ventricular depolarization
- T wave: Ventricular repolarization
- ST segment: Isoelectric line (no electrical activity)
Assessment of the Cardiovascular System
- History: Ask about chest pain, shortness of breath, fatigue, edema, dizziness, palpitations.
- Physical Exam: Auscultate heart sounds, palpate peripheral pulses, assess for jugular vein distention, and any edema.
Common Symptoms
- Chest pain
- Shortness of breath
- Fatigue
- Edema
- Dizziness
- Palpitations
Physical Assessment of the Cardiovascular System
- Auscultation of Heart Sounds: Listen for murmurs, gallops, and heart sounds.
- Palpation of Peripheral Pulses: Assess the quality of the pulses and compare bilaterally.
- Jugular Vein Distention: Assess for venous distention, which may indicate right heart failure.
- Edema: Assess for edema, which may indicate fluid overload or heart failure.
Most Reliable Source for Pulse:
- Apical Pulse
Laboratory Tests
- CBC: Complete Blood Count assesses red blood cells, white blood cells, and platelets
- Electrolytes: Measures the balance of electrolytes in the blood.
- Kidney function: Checks kidney function
- Cardiac enzymes: Measures the levels of troponin and creatine kinase (CK-MB) in the blood. These enzymes are released into the bloodstream whenever there is damage to the heart muscle.
- Coagulation studies: To assess the ability of the blood to clot.
- Lipid profile: Measures cholesterol and triglycerides in the blood.
CAD (Coronary Artery Disease)
- Atherosclerosis (hardening and narrowing of the arteries), which is a major cause of heart disease
- Angina is a common symptom
- MI is a serious complication
- Risk factors: Family history of heart disease, hypertension, high cholesterol, smoking, diabetes, obesity, physical inactivity, and certain medications.
- Lifestyle modifications: A heart-healthy diet (low in saturated fat, cholesterol, and sodium) and regular exercise.
- Medications: Used to treat high cholesterol, high blood pressure, and other risk factors.
Angina
- Chest pain caused by a temporary lack of oxygen to the heart muscle
- Angina usually occurs with exertion and subsides with rest.
- Stable Angina: Predictable chest pain that occurs during exertion. Relieved within minutes with rest or nitroglycerin.
- Unstable Angina: New or worsening chest pain that occurs at rest or with less exertion than usual, or lasts longer than usual.
Hypertension
- High blood pressure
- A major risk factor for heart disease, stroke, kidney disease, and other health problems.
- Silent killer, as it often has no symptoms.
- Lifestyle modifications
- Medications: Used to lower blood pressure.
Myocardial Infarction (MI)
- A heart attack
- Caused by a complete blockage of a coronary artery
- Symptoms include chest pain, shortness of breath, nausea, vomiting, and sweating
- Immediate medical attention is needed.
- STEMI: A type of MI that causes a complete blockage and visible (ST segment) changes on an EKG.
- Non-STEMI: MI with a partial blockage and EKG changes.
Heart Failure
- A complex syndrome characterized by the heart's inability to pump enough blood to meet the body's needs
- Can be caused by several conditions, including coronary artery disease, hypertension, and valvular heart disease.
- Some cases are reversible, depending on the cause.
- Most HF is chronic, progressive, and managed with lifestyle changes and medications.
Chronic Heart Failure
- Chronic heart failure develops over time, where the heart muscle is weakened and can no longer pump effectively.
Clinical Manifestations of Heart Failure
- Right-sided Heart Failure: Ineffective pumping of the right ventricle causes backflow of blood to the body's periphery .
- Left-Sided Heart Failure: Ineffective pumping of the left ventricle causes backflow of blood to the lungs. Left-sided heart failure can progress to right-sided heart failure without treatment.
Medical Management of the Patient with Heart Failure
- Lifestyle modifications
- Medications
Treatments
- Diuretics: Reduce fluid retention
- Vasodilators: Dilate blood vessels, reducing the workload of the heart.
- ACE Inhibitors: Inhibit the conversion of angiotensin I to angiotensin II, which helps lower blood pressure.
- Beta Blockers: Block beta-adrenergic receptors, which helps lower blood pressure and improve heart function.
- Digitalis: Increases the force of heart contractions.
Medications used to Treat HF
- Diuretics
- ACE Inhibitors
- Beta Blockers
- Digitalis
- Nitrates
- Vasodilators
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Description
This quiz covers the roles of various members of the surgical team and the preoperative assessment process. It includes information on medications that may impact the surgical experience, as well as the importance of patient history and assessments before surgery. Test your knowledge of surgical protocols and practices.
