permission granted in the knowledge of the
possible consequences, typically that which is
What is informed consent?
given by a patient to a doctor for treatment with
full knowledge of the possible risks and benefits.
physician
Who is responsible for obtaining informed
consent?
What can the nurse do in terms of informed re-teach what the physician has taught already and obtain signature after patient has
consent? received teaching from physician
1- determine PT understanding of surgery, complications, interventions, answer
questions, and provide appropriate education
2- confirm informed consent
What are the four goals of the pre-op
3- determine PT anxiety level/source and manage accordingly
assessment? who completes this
4- obtain relevant info like PT identity, verify NPO status, meds taken, health history,
assessment?
allergies, and family support level
***completed by the perioperative nurses in the preop area
- Lab assessments: blood typing, metabolic panel, coagulation studies, CBC, urine
tests for glucose, blood, proteins, specific gravity, ketone presence, and HGH in
What diagnostics should be completed
women of child bearing age
before surgery?
- Radiologic assessments: MRI, CAT scan, ultrasound, x-ray, or ECG
How long should a PT be NPO prior to 8 hr for solid foods, 2 hrs for clear liquids
surgery?
, to reduce risk for aspiration?
Why should a patient be NPO prior to
surgery?
What medication can be given before corticosteroids, anti-convulsants, and insulin
surgery?
NPO status has not been followed, diagnostics come back showing issues with
What might cause a surgery to be held?
clotting or low blood cell counts, patient expresses withdrawal of consent
What is the best way to handle patient express that their concern is normal and encourage them to speak with the surgeon
anxiety about surgery? about their concerns. EDUCATION ALLEVIATES ANXIETY
jewelry, body piercings, makeup, deodorant, perfume/cologne, hair pins, dentures,
contacts, glasses, prosthetics
What items should be removed prior to
***everything besides underwear, pacemaker, and lines
surgery? why?
electrocautery unit is used to cauterize incisions, metal may cause electrical
conduction to surrounding tissues
What should be verified during the time correct patient, procedure, and site
out?
what area should be maintained as sterile OR table, area surrounding it, equipment/Mayo stand, and instrument table
to maintain surgical asepsis?
- surgeon, surgical assistants, scrub nurse, and surgical technologist
Who should be sterile, and how should
- scrub arms and hands with disinfecting soaps, wear surgical gowns, caps, eyewear,
they scrub in?
sterile gloves, sturdy foot wear, keep hands above the waistline and away from chest
- hypotension: ensure slow movement, administer fluids
- hypertension: nitroglycerine, beta blockers, other antihypertensives
- fluid and electrolyte imbalances: admin fluids, supplements, or diuretics
What are some side effects of anesthesia accordingly
and the treatment for each? - residual muscle paralysis: admin a cholinergic drug like neostigmine to reverse
anticholinergic toxicity
- malignant hyperthermia: administer dantrolene and cool patient via cold IV NS, ice
bags, and cold NG lavage
skeletal muscle rigidity, unexplained tachycardia,
What are the signs of malignant hypercarbia (seen by anesthesia provider),
hyperthermia? myoglobinuria (dark brown urine), and
hyperthermia
1- induction: IV access, monitors placed, O2 administration via face mask, muscle
relaxant or narcotics are infused, propofol induction, adequate sedation reached
2- intubation
3- maintenance: maintain sedation with balanced anethesia
What are the 5 stages of general
4- emergence: too sedated= suction to reduce laryngospasm and aspiration, reverse
anesthesia?
excess muscle relaxant, provide oxygen to reverse inhaled agents, remove airway
when PT breathes on their own or follows commands
5- recovery: transport to PACU or ICU, monitor vitals, continue oxygenation until
stable
time out, equipment safety check, sterile technique, assist w/ intubation, ground PT
What are the responsibilities of the as indicated, keep patient safety belt in place, SCD and support hose, keep PT warm,
circulating/scrub nurse? maintain sterile field, count in and out ALL supplies, measure irrigation fluid, keep OR
doors closed, keep hallways clear of equipment