Med Surge 331 Exam 1 STUDY GUIDE
Perioperative module 1
Perioperative module
I. Preoperative care: Can be months long or emergent- ends when they enter the OR
II. Preop Checklist
a. Complete physical exam
b. Review of systems
c. Medical and surgical history
d. Evaluate laboratory findings
i. Include pregnancy test-we do not operate (especially electively) on pregnant women
e. Make sure labs are normal going in
III. Preop teaching- good to teach what they need to do postop before surgery
IV. Informed consent
a. Surgeon explains procedure and ensures Pt understands.
b. Nurse is the witness to the Pt signature, that they aren’t being coerced. Need to make sure patient
understands the surgery
V. Surgical risk: health concerns, older adult
I. Factors that Increase Surgical Risk
a. Age: very young and older population-more at risk
b. Obesity: extra tissue/skin, extra pressure on the heart, extra stress on the body
c. Malnutrition: lack muscle mass, underweight, not enough protein for healing, anemic
d. Dehydration: maintain fluids and electrolytes, affects circulation
e. Cardiovascular & Respiratory disease: extra stress of heart and body
f. Diabetes: Don’t heal well, circulatory and cardiovascular issues, circulation, blood sugar
g. Renal & liver disease: responsible for medication/anesthesia metabolism/breakdown
i. Alcoholism: decreased liver function, prolonged anesthetic, altered nutritional status
h. Nicotine: stop smoking 6 weeks before surgery due to risks of pulmonary complications during and after
surgery.
i. Medications
i. Nicotine use
ii. Medications
iii. Anticoagulants
iv. Diuretics
v. Phenothiazines
1. used to treat psychiatric illness ie schizophrenia; other psychotic disorders; dangerous
because can cause increased CNS depression and hypotension when used during
surgery; similar with MAOIs
vi. MAOI’s
vii. Antidepressants: Some can potentiate the effects of opioids
viii. Antihypertensives: Predispose the patient to shock from combined effect of drug and the
vasodilator effect of some anesthetic agents
ix. insulin coin may require adjustments due to increased body metabolism, decreased oral intake,
stress, anesthesia
II. preop diagnostic studies [Lewis table 17.5]
a. Evaluate laboratory findings-
i. Include pregnancy test-we do not operate (esp electively) on pregnant women
b. Make sure labs are normal going in
1
, c. ABGs
III. Intraoperative care
a. Roles of the nurse
i. Can be circulating nurse, scrub nurse or assists- know these jobs
ii. Circulator: usually does Time Outs- do them several times and out loud
1. Documents everything
iii. Circulating nurse
1. Remains in unsterile field, monitor, call time-outs, document, assist, grabs other
instruments, label for pathology, count instruments
2. Usually in charge of Time Outs- do them several times and out loud
a. Documents everything
iv. Scrub nurse/Tech:
1. Designated surgical hand antisepsis procedure, gowned and gloved in sterile attire.
v. Surgeon
1. Physician who performs procedure. Responsible for preoperative medical history,
physical assessment, discussing risks and alternatives , patient safety, management in
OR, post operative management.
vi. Surgical assistant
1. Physician as assistant during surgical procedure.
vii. Anesthesia personal
1. In charge of Pt, monitor vitals, organs, stability of Pt, asepsis
b. Malignant hyperthermia- biggest concern.
i. Hereditary- if someone had a major OR complication, we need to be ready and aware and
watching for S/Sx
1. Take family and surgical history
c. Safety Concerns
i. Want to keep patient warm cause ORs get cold
ii. SCDs- want to keep blood circulating
iii. Position is important- if body is in a position that’s uncomfortable, they’re under anesthesia and
can’t feel
1. Make sure the body is aligned
d. you do not need to know the anesthesia medications
e. Table 18.1: Intraoperative Nursing Activities
i. circulating, non sterile activities
1. Help prepare room, ensuring that supplies and equipment are available, in working
order, and sterile
2. maintains aseptic technique in all required activities
3. monitors practices of aseptic technique in selfon others checks mechanical and electrical
equipment and environmental factors
4. conducts pre procedure verification process
5. confirms and implements facility protocols and safety measures
6. assess patients physical and emotional status
7. assist with an insurance patient safety and transferring and positioning patient
8. aids and anesthesia induction’
9. monitors draping
10. takes part in surgical timeout
11. records intra operative care
12. measures blood, urine output, and other fluid loss
13. facilitate patient transfer to PACU
14. gives handoff report to PACU nurse with information relevant to care patient
2
, ii. scrubbed, sterile activities
1. helps prepare the R
2. prepares instrument table and arranges sterile equipment for functional use
3. passes instruments to surgeon an assistance by anticipating their needs
4. keep scratch count of sponges, needles, instruments, and medical devices that could be
retained in the patient
5. keep track of irrigation solutions used for calculation of blood loss
6. accepts, verifies, and reports drugs used by the surgeon or ACP, including local
anesthetics
f. Table 18.2: Common peri operative nursing activities
Postoperative care
o Starts the second they leave the OR
o Goes to PACU when they’re stable
o Initial PACU Assessment: Table 19.3
Airway
Patency, oral or nasal airway, laryngeal mask airway, endotracheal tube with ventilator
settings
Breathing
respiratory rate in quality
auscultated breath sounds
postdocs
capnography or other technologies supporting monitoring if indicated
supplemental oxygen
Circulation
Neurologic
level of consciousness, orientation, sensory and motor status, people size of reaction
Surgical site
dressings invisible incisions, drains (type, patency, and drainage), IV assessment (location
and condition of sites, solutions infusing)
Genitourinary
Urine output
GI
nausea, vomiting, intake, output, bowel sounds
Pain
incision or other
Patient safety needs
patient position, fall risk assessment
o Signs if Inadequate Oxygenation: Table 19.4
Cardiovascular system
HTN, hypertension, tachycardia, Brady cardia, dysrhythmias, delayed capillary refill,
weak peripheral pulses, decreased O2 saturation
CNS
Restlessness, agitation, confusion, muscle twitching, seizures, coma
Integumentary system
flushed, cool, moist skin, cyanosis
Renal system
urine output < 0.5 mL/kg/hr
Respiratory system
3
Perioperative module 1
Perioperative module
I. Preoperative care: Can be months long or emergent- ends when they enter the OR
II. Preop Checklist
a. Complete physical exam
b. Review of systems
c. Medical and surgical history
d. Evaluate laboratory findings
i. Include pregnancy test-we do not operate (especially electively) on pregnant women
e. Make sure labs are normal going in
III. Preop teaching- good to teach what they need to do postop before surgery
IV. Informed consent
a. Surgeon explains procedure and ensures Pt understands.
b. Nurse is the witness to the Pt signature, that they aren’t being coerced. Need to make sure patient
understands the surgery
V. Surgical risk: health concerns, older adult
I. Factors that Increase Surgical Risk
a. Age: very young and older population-more at risk
b. Obesity: extra tissue/skin, extra pressure on the heart, extra stress on the body
c. Malnutrition: lack muscle mass, underweight, not enough protein for healing, anemic
d. Dehydration: maintain fluids and electrolytes, affects circulation
e. Cardiovascular & Respiratory disease: extra stress of heart and body
f. Diabetes: Don’t heal well, circulatory and cardiovascular issues, circulation, blood sugar
g. Renal & liver disease: responsible for medication/anesthesia metabolism/breakdown
i. Alcoholism: decreased liver function, prolonged anesthetic, altered nutritional status
h. Nicotine: stop smoking 6 weeks before surgery due to risks of pulmonary complications during and after
surgery.
i. Medications
i. Nicotine use
ii. Medications
iii. Anticoagulants
iv. Diuretics
v. Phenothiazines
1. used to treat psychiatric illness ie schizophrenia; other psychotic disorders; dangerous
because can cause increased CNS depression and hypotension when used during
surgery; similar with MAOIs
vi. MAOI’s
vii. Antidepressants: Some can potentiate the effects of opioids
viii. Antihypertensives: Predispose the patient to shock from combined effect of drug and the
vasodilator effect of some anesthetic agents
ix. insulin coin may require adjustments due to increased body metabolism, decreased oral intake,
stress, anesthesia
II. preop diagnostic studies [Lewis table 17.5]
a. Evaluate laboratory findings-
i. Include pregnancy test-we do not operate (esp electively) on pregnant women
b. Make sure labs are normal going in
1
, c. ABGs
III. Intraoperative care
a. Roles of the nurse
i. Can be circulating nurse, scrub nurse or assists- know these jobs
ii. Circulator: usually does Time Outs- do them several times and out loud
1. Documents everything
iii. Circulating nurse
1. Remains in unsterile field, monitor, call time-outs, document, assist, grabs other
instruments, label for pathology, count instruments
2. Usually in charge of Time Outs- do them several times and out loud
a. Documents everything
iv. Scrub nurse/Tech:
1. Designated surgical hand antisepsis procedure, gowned and gloved in sterile attire.
v. Surgeon
1. Physician who performs procedure. Responsible for preoperative medical history,
physical assessment, discussing risks and alternatives , patient safety, management in
OR, post operative management.
vi. Surgical assistant
1. Physician as assistant during surgical procedure.
vii. Anesthesia personal
1. In charge of Pt, monitor vitals, organs, stability of Pt, asepsis
b. Malignant hyperthermia- biggest concern.
i. Hereditary- if someone had a major OR complication, we need to be ready and aware and
watching for S/Sx
1. Take family and surgical history
c. Safety Concerns
i. Want to keep patient warm cause ORs get cold
ii. SCDs- want to keep blood circulating
iii. Position is important- if body is in a position that’s uncomfortable, they’re under anesthesia and
can’t feel
1. Make sure the body is aligned
d. you do not need to know the anesthesia medications
e. Table 18.1: Intraoperative Nursing Activities
i. circulating, non sterile activities
1. Help prepare room, ensuring that supplies and equipment are available, in working
order, and sterile
2. maintains aseptic technique in all required activities
3. monitors practices of aseptic technique in selfon others checks mechanical and electrical
equipment and environmental factors
4. conducts pre procedure verification process
5. confirms and implements facility protocols and safety measures
6. assess patients physical and emotional status
7. assist with an insurance patient safety and transferring and positioning patient
8. aids and anesthesia induction’
9. monitors draping
10. takes part in surgical timeout
11. records intra operative care
12. measures blood, urine output, and other fluid loss
13. facilitate patient transfer to PACU
14. gives handoff report to PACU nurse with information relevant to care patient
2
, ii. scrubbed, sterile activities
1. helps prepare the R
2. prepares instrument table and arranges sterile equipment for functional use
3. passes instruments to surgeon an assistance by anticipating their needs
4. keep scratch count of sponges, needles, instruments, and medical devices that could be
retained in the patient
5. keep track of irrigation solutions used for calculation of blood loss
6. accepts, verifies, and reports drugs used by the surgeon or ACP, including local
anesthetics
f. Table 18.2: Common peri operative nursing activities
Postoperative care
o Starts the second they leave the OR
o Goes to PACU when they’re stable
o Initial PACU Assessment: Table 19.3
Airway
Patency, oral or nasal airway, laryngeal mask airway, endotracheal tube with ventilator
settings
Breathing
respiratory rate in quality
auscultated breath sounds
postdocs
capnography or other technologies supporting monitoring if indicated
supplemental oxygen
Circulation
Neurologic
level of consciousness, orientation, sensory and motor status, people size of reaction
Surgical site
dressings invisible incisions, drains (type, patency, and drainage), IV assessment (location
and condition of sites, solutions infusing)
Genitourinary
Urine output
GI
nausea, vomiting, intake, output, bowel sounds
Pain
incision or other
Patient safety needs
patient position, fall risk assessment
o Signs if Inadequate Oxygenation: Table 19.4
Cardiovascular system
HTN, hypertension, tachycardia, Brady cardia, dysrhythmias, delayed capillary refill,
weak peripheral pulses, decreased O2 saturation
CNS
Restlessness, agitation, confusion, muscle twitching, seizures, coma
Integumentary system
flushed, cool, moist skin, cyanosis
Renal system
urine output < 0.5 mL/kg/hr
Respiratory system
3
