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TEST 3 Surgical Asepsis Pre-Op: RRL | NURS - Nursing Science 2 - Intermediate, Quizzes of Nursing

Surgical Asepsis: Pre-op Rita Revak-Lutz Introduction Class: NURS - Nursing Science 2 - Intermediate; Subject: Nursing; University: Santa Fe Community College; Term: Forever 1989;

Typology: Quizzes

2010/2011

Uploaded on 01/29/2011

kelcuddihy
kelcuddihy 🇺🇸

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TERM 1
Role of the Perioperative Nurse:
DEFINITION 1
Umbrella term that describes care of client from the time
decision is made to have the surgery, until discharge from
the hospital
TERM 2
Role of the Perioperative Nurse: Four phases
of operative experience:
DEFINITION 2
Pre_Op prior to surgery Intaoperative during surgery
Immediate post-operative 1-4 hours after surgery
Convalescent: Intermediate:4-24HRS POST OP Extended:24-?
TERM 3
DIAGNOSTIC SURGERY
DEFINITION 3
Confiration or establishment of a diagnosis. ex. Laproscopic
procedures
TERM 4
EXPLORATORY SURGERY
DEFINITION 4
(Ex. endometrious find extent of surgery) surgical
examination to determine the nature of extent of a disease
TERM 5
ABLATIVE SURGERY
DEFINITION 5
remove a diseased body part. (ex. gangren toe removed
appendectomy)
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Download TEST 3 Surgical Asepsis Pre-Op: RRL | NURS - Nursing Science 2 - Intermediate and more Quizzes Nursing in PDF only on Docsity!

Role of the Perioperative Nurse:

Umbrella term that describes care of client from the time decision is made to have the surgery, until discharge from the hospital TERM 2

Role of the Perioperative Nurse: Four phases

of operative experience:

DEFINITION 2 Pre_Op prior to surgery Intaoperative during surgery Immediate post-operative 1-4 hours after surgery Convalescent: Intermediate:4-24HRS POST OP Extended:24-? TERM 3

DIAGNOSTIC SURGERY

DEFINITION 3 Confiration or establishment of a diagnosis. ex. Laproscopic procedures TERM 4

EXPLORATORY SURGERY

DEFINITION 4 (Ex. endometrious find extent of surgery) surgical examination to determine the nature of extent of a disease TERM 5

ABLATIVE SURGERY

DEFINITION 5 remove a diseased body part. (ex. gangren toe removed appendectomy)

Reconstructive or Cosmetic SURGERY

to restore fuction or appearance TERM 7

EMERGENT SURGERY

DEFINITION 7 Preformed immediately to preserve function or the life of the client (ex. C-section, pic of lady shot in face received emergent surgery to save her life) TERM 8

URGENT SURGERY

DEFINITION 8 necessary to be preformed within 1-2 days. (ex. getting a heart stent if not emergent) TERM 9

Elective Surgery

DEFINITION 9 Scheduled and planned to provide preferred treatment for a condition. (ex. planned c section) TERM 10

-ectomy

DEFINITION 10 excission or removal of ex appendectomy

-plasty

repair or reconstruction of ex. mammoplasty TERM 17

operative permit

DEFINITION 17 client must sign a voluntary and informed consent or permit for surgery Protects patient Protects surgeon and hospital staff TERM 18

Informed Consent

DEFINITION 18 active, shared decision-making process between provider and recipient of care Back in the day people with mental retardation were sterilized without informed consent to prevent making more retards. TERM 19

Conditions for valid consent: 1. Adequate

disclosure of diagnosis

DEFINITION 19

  1. Adequate disclosure of diagnosis Nature and purpose of treatment Risks and complications Probability of success Availability, benefit, and risk of alternative treatment Prognosis without treatment TERM 20

Conditions for valid consent: Dem. of clear

understanding and comprehension of info

provided

DEFINITION 20

  1. Demonstration of clear understanding and comprehension of information provided Consent signed prior to any preoperative medication is given

Conditions for valid consent: 3. Voluntary

consent

No coercion used to obtain consent Right to refuse consent and surgery Right to withdraw consent after signing permit ex. If women in labor needs an emergent c-section but is refusing surgery and baby dies, that is her choice. Do not judge pt. could have been raped or unplanned and cannot afford baby. TERM 22

Legal Aspects of Surgery Conditions for valid

consent:

DEFINITION 22 If the patient is a minor, unconscious or mentally incompetent, the permission of a responsible family member or legal guardian is obtained If under 18 and living away from home, or under 18 and pregnant, they are considered an emancipated minor and may sign their own consent In emergent situation (life saving) situation and not able to obtain informed consent, surgeon may institute treatment without written consent TERM 23

Surgeons responsibility:

DEFINITION 23 Ensure that client is giving informed consent Explanation of Surgical procedure Risks, including potential for death, need for blood transfusion Alternatives to surgery TERM 24

Legal Aspects of Surgery Role of Nurse

DEFINITION 24 Ensure consent is informed and voluntary Sound mind Not sedated Understands English Understands what the surgeon said Obtains and witnesses the patients signature Contact the physician and explain the need for additional information TERM 25

Legal Aspects of Surgery Role of Student

Nurse

DEFINITION 25 MAY NOT witness consent Ensure pre-op meds are not given prior to consent Relay any questions that the client may have

Surgery as a Stressor Disrupted vascular

system

Disrupted vascular system Interruption in blood vessels Increased platelets may lead to increased clotting TERM 32

Surgery as a Stressor Disturbed Organ

Function

DEFINITION 32 Manipulation of bowel may lead to decreased peristalsis TERM 33

Surgery as a Stressor Body Image

Disturbance

DEFINITION 33 Incision may effect body image amputation of limbs, mastectomy TERM 34

Surgery as a Stressor Lifestyle Changes

DEFINITION 34 Consider the effect of a colostomy, amputation of limbs TERM 35

Assessing Surgical Risk: Age VERY

YOUNG

DEFINITION 35 Poorly developed lungs: less able to tolerate surgery as lungs have less range for stress: increased risk of pulmonary problems Thin skin: Prone to breakdown Increased problems with healing *******young may have oxygenation problems, thin skin, and problems healing. If young in pain less likely to eat making them less likely to thrive/heal properly.

Assessing Surgical Risk: Age Elderly Aeration

and Circulation

Aeration: Decreased gas exchange- Respiratory Acidosis decreased vital capacity decreased cough reflex Circulation: Decreased arterial elasticity Increased plaque formation Risk for clotting can be elevated TERM 37

Asessing Surgical Risk: Age Elderly Renal and

Sensation

DEFINITION 37 Renal: Decreased GFR: Decreased drug excretion Urinary stasis-risk for infection Urinary Incontinence -ego blow for independent elder Sensation: Decreased sight (rods and cones less functional light perception decreases with age) Decreased hearing Decreased short term memory Impaired Balance-make sure bed low, 2 rails up, call light accessible TERM 38

Asessing Surgical Risk: Age Elderly Skin

DEFINITION 38 Skin: Decresased elasticity Dec. collagen Thin, increased risk of impairment TERM 39

Asessing Surgical Risk: Age Elderly Mobility

and Nutrition

DEFINITION 39 Mobility: *Loss of calcium from bones: prone to fracture *Decreased activity: Decreased basal metabolic rate Nutrition: *Dehydration-check hydration status when admitted *Malnutrition-may look fin but be nutrient deficient, this may impair healing TERM 40

Assessing Surgical Risk: Nutrition

Prolonged....

DEFINITION 40 Obese Client: Excess adipose tissue and poor blood supply *Prolonged Surgery -----increased time to make incision ----- increased time to close incision Prolonged excretion of anesthetic agent ---Anesthetic agents stay longer in adipose tissue because of poor blood supply in adipose, this takes them longer to wake up, which will decrease respiratory ability which increases risk of fluid in the lungs pneumonia etc.

Assessing Surgical Risk: Fluid and Electrolyte

Balance

Adequate fluid and electrolyte balance is needed to maintain blood volume and urinary output Excess fluids: Excess Fluids: can effect their cardiac and pulmonary function TERM 47

Adequate fluid and electrolyte balance is

needed to maintain blood volume and urinary

output Electrolyte imbalance

DEFINITION 47 Too little fluids: Results in dehydration and reduced blood volume Low Blood pressure, impaired GFR, and delayed excretion of drugs Electrolyte Imbalance: Can be retaining sodium and water and excreting potassium Hypokalemia- leads to heart arrythmias TERM 48

Impact of Pre-existing Conditions on Surgical

Risk Bleeding disorders

DEFINITION 48 *Bleeding Disorders- Thrombocytopenia and hemophilia may both lead to uncontrolled post-operative bleeding. Pts with thrombocytopenia MUST TELL ANASTESIOLOGIST bc anesthesiologist cannot do epidural or spinal they get local TERM 49

Impact of Pre-existing Conditions on Surgical

Risk: Diabetes

DEFINITION 49 Diabetes: Impaired peripheral circulation contributes to impaired wound healing Stress increases blood glucose, which can further impair wound healing, and increase risk of infection. TERM 50

Impact of Pre-existing Conditions on Surgical

Risk Heart Disease

DEFINITION 50 Heart Disease: Stress increases workload on heart, so increased risk of infarction, MI, angina, CHF

Impact of Pre-existing Conditions on Surgical

Risk Fever

Fever: Pre-operative fever may indicate an infection that can greatly impact surgery: make sure that surgeon and anesthesiologist is aware. TERM 52

Impact of Pre-existing Conditions on Surgical

Risk Upper Resp. Infection

DEFINITION 52 Upper Respiratory Infection Anesthesia and URI may further increase secretions, which can ^ surgical recovery time TERM 53

Impact of Pre-existing Conditions on Surgical

Risk Chronic Respiratory Infection

DEFINITION 53 Chronic Respiratory Disease Emphysema bronchitis, asthma may have difficulty coughing May have difficulty handling ^ secretions TERM 54

Impact of Pre-existing Conditions on Surgical

Risk Liver disease

DEFINITION 54 Liver Disease: At risk for drug toxicity At risk for impaired wound healing TERM 55

Impact of Pre-existing Conditions on Surgical

Risk immune disorders

DEFINITION 55 immune Disorders: At risk for infections Delayed wound healing.

Pre-Op Assess: Nursing Assessment and

History: Endocrine: diabetes

  1. History of diabetes: what is current treatment regimen? If on oral agents, may need insulin post-op because of stress Frequency of post-op glucose checks Current blood glucose Last intake of insulin or oral meds (metformin?) TERM 62

Pre-Op Assess: Nursing Assessment and Hx:

Endocrine: History of thyroid disease

DEFINITION 62 Plan for pharmacologic therapy pre-op steroids will be needed intra and post op as well 1. History of chronic steroid use: Adrenal glands produce 25 mg/day of cortisol Surgical stress increases this to 250-300 mg/day, providing needed energy for surgery Chronic steroid use atrophies adrenal glands and suppresses cortisol secretion Must supplement with IV cortisol to avoid Addisonian crisis TERM 63

Pre-Op Assess: Nursing Assessment and

History Immunologic

DEFINITION 63

  1. Allergies: drugs, environmental, latex, tapes, betadine Allergy band and note prominently on chart 2. WBC: Acute infection ***^ WBC : but neutrophils are immature cells known as "bands" ***^ neutrophils ***^ bands TERM 64

Pre-Op Assess: Nursing Assessment and

History: Drug Therapy

DEFINITION 64 1.What prescribed , OTC, and herbal drugs are they currently taking? 2. Coumadin: what is PT/INR 3. Diuretics: can potentiate electrolyte imbalances 4. B/P, cardiac meds: can interact with anesthesia and result in hypotension and bradycardia 5. Insulin St. Johns Wort interferes with anesthesia Ask if they are on steroids TERM 65

Pre-Operative Assessment :Physiological

Common Pre-op Screenings and Examinations

DEFINITION 65 1.CBC 2. UA 3. Chest X-Ray 4. EKG 5. Coagulation studies 6. Electrolytes 7. Serum Creatinine 8. Type & Cross for blood Please review Lewis, Table 18-6 for rationales

Pre-Operative Assessment: Psychological 1.

Anxiety

Look for cues of anxiety Physiological Behavioral Nurse can allay anxiety Therapeutic communication Determine source of anxiety Clear up misconceptions TERM 67

Pre-Operative Assessment: Psychological

Fear: many causes for fear

DEFINITION 67 Unknown: may be first surgery Pain and pain management Concern with body image/ change in image Death Anesthesia Disruption of life: having to be dependent on others TERM 68

Pre-Operative Assessment: Psychological

Ability or inability to cope

DEFINITION 68 Does client exhibit ability to problem-solve? How have they coped with past stressors? Have they had past surgeries? If so, what helped them cope at that time? TERM 69

Pre-Op. Assessment: Psychological Knowledge

surgery, anesthesia, &their role

DEFINITION 69 Does the client know what they need to know? Support system Do they have a support system? What are the post- operative plans? TERM 70

Pre-Operative Assessment: Sociocultural

DEFINITION 70 Support System Economic Plans for convalescence

Knowledge Deficit Pre-op Antiemetics: what to

do with routine, prescribed medications

A. Antiemetics: Reglan, Zofran Antiemetics: Dec N/v Increases GI emptying which decreases risk of aspiration. TERM 77

Nursing Diagnoses: Knowledge Deficit Pre-op

Meds H2 Receptor antagonists

DEFINITION 77 H2 Receptor antagonists: Tagamet, Pepcid, Zantac inhibit gastric secretion Decrease risk of stress ulcers PRESENT ::::::80-90% of people in hospital get H2 receptor antagonist to reduce the risk of stress ulcers. TERM 78

Nursing Diagnoses: Knowledge Deficit Pre-op

Meds Benzodiazepines

DEFINITION 78 Benzodiazepines: Valium, Versed, Ativan Benzos- reduces anxiety increases sedation induces amnesia TERM 79

Nursing Diagnoses: Knowledge Deficit: Pre-op

Med Anticholinergics

DEFINITION 79 Anticholinergics: Atropine, scopolamine, glycopyrrolate Decrease oral and respiratory secretions Prevent bradycardia TERM 80

Nursing Diagnoses: Knowledge Deficit Pre-op

Med: Bowel Preps

DEFINITION 80 Bowel Preps: Enema, Magnesium Citrate, Antibiotics, Low- residue Diet clense bowel prior to bowel surgery.

Nursing Diagnoses: Knowledge Deficit Pre-

Operative Skin Prep

Cleansing skin Clipping or shaving hair TERM 82

Nursing Diagnoses: Knowledge Deficit: Pre-op

Family Support Knowledge Deficit Pre-

Operativ

DEFINITION 82 Tell family when to arrive prior to surgery Direct them to appropriate waiting area Discuss how they will be contacted TERM 83

Nursing Diagnoses: Risk for Injury:Client

preparation on surgical day

DEFINITION 83 Make sure client voids prior to being given meds Double check that consent is signed prior to being given meds Give meds as ordered Ensure safety Siderails up Bed in low Call light TERM 84

Nursing Diagnoses: Risk for Injury 2. Pre-

operative checklist A-G

DEFINITION 84 A. Check ID/Allergy band B. Name on chart C. Permit signed D. H & P/ anesthesia questionnaire on chart, with ht & wt E. Prep done, if ordered F. Pre-op screening/exams on chart G. Recent set of VS on chart TERM 85

Nursing Diagnoses: Risk for Injury 2. Pre-

operative checklist H-M

DEFINITION 85 H. Jewelry removed or secured I. Dentures, glasses, contacts, prosthesis, nail polish, hairpins removed J. Hospital gown on K. Voided prior to being given on call meds L. NPO status verified M. Pre-op meds given if ordered

Concept Map of Anesthesias Effects on

Respiratory System

Anesthesia / \ ^ lung secretions causes respirations to be shallow
/ Secretions in lower airways 1.? 2.? Cough deep breath incentive spirometer TERM 92

Nursing Diagnoses Knowledge Deficit:

Postoperative 5. Cardiovascular exercises

DEFINITION 92 Leg exercises Stimulates circulation by promoting venous return to heart Prevents thrombus formation Kozier Procedure 35-1 Dorsiflexion and plantar flexion of feet Knee flexion and extension Raising and lowering legs TERM 93

Nursing Diagnoses Knowledge Deficit:

Postoperative 5. Cardiovascular exercises/

stuff

DEFINITION 93 Antiemboli Stockings/ Sequential Compression Devices (Kozier Skills 37-2, 51-1) Facilitate venous return Improve arterial circulation to the feet and prevent edema DO NOT TAKE PLACE OF LEG EXERCISES: only facilitates muscle contraction TERM 94

Nursing Diagnoses Knowledge Deficit:

Postoperative 6. Turning

DEFINITION 94 Mobilizes respiratory secretions to dependent portions of the lungs Move q 1-2 hours while awake