A Flashcards by Mary Therese Trimanez

PREOPERATIVE NURSING

a nursing specialty that works with patients who are having operative or invasive procedures.

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T/F

Preoperative nursing is only the nursing care during the operation

FALSE: Before, during and after the operation

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works closely with Surgeons, Anesthesiologists, Nurse Anesthetists, Surgeon’s Assistants, Surgical Technologists and Nurse Practitioners

PREOPERATIVE NURSE

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PRIMARY GOAL OF PERIOPERATIVE NURSING

Safety and welfare of the client in all phases of the perioperative experience

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branch of medicine that encompasses pre-operative, intra-operative judgments and management, and post-operative care of patients.

Surgery

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invasive incision into body tissue or minimally invasive entrance into a body cavity for either therapeutic or diagnostic purposes during which protective reflexes or self- care abilities are potentially compromised.

Surgical Procedure

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absence of microorganisms that cause disease

Asepsis

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prevention of sepsis by destruction or inhibition of growth or multiplication of microorganisms from body tissue or fluids

Antisepsis

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inorganic chemical compound that combat sepsis by inhibiting growth of microorganisms without necessarily killing them. Used in skin/tissues without destroying them.

Antiseptic

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inhibition growth of bacteria

Bacteriostasis

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apparently healthy person who harbors and can transmit a pathogenic Microorganism

Carrier

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agents that kill growing or vegetative form of microorganism that completely eliminating them form inanimate objects

Disinfectants

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Types of Disinfectants:

Bactericide
Fungicide
Sporicide
Virucide

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bacteria or fungi normally inhabiting the body

Flora

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free of microorganisms including spores

Sterile

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the method by which contamination with microorganism is prevented to maintain sterility all throughout the operative procedure

Sterile/Aseptic technique

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the area around the incision site or site of introduction of any instrumentation that has been prepared for use of sterile supply and equipment

Sterile field

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the process by which all
pathogenic and non-pathogenic
microorganism are killed
including spores

Sterilization

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the chamber or equipment used
to attain physical or chemical
sterilization. Also known as
autoclave

Sterilizer

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above/beyond

SUPRA

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above/beyond

SUPRA

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joint

ARTHRO

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bule/gallbladder

CHOLE

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urinary bladder

CYSTO

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intestine

ENTERO

HYSTERO

Uterus

NEPHRO

kidney

MAST

breast

Nerve

Neuro

Lungs

Pneumo

Pyelo

Kidney/Pelvis

Thoraco

Chest

Muscle

Myo

Oophor

Ovaries

Fallopian Tube

Salpigno

-oma

tumor

-ectomy

Removal of organ or gland

Stitching or a part of an organ

-rrhaphy

making an | opening or stoma

-ostomy

to repair or restore

-plasty

-cele/coele

hernia/swelling (denoting to a cavity or | space)

-itis

inflammation

Common categories for sugery

``` Aim Urgency Seriousness Field Surgical Approach ```

A surgery that can establish whether a person has a particular illness, disease or condition,

Diagnostic

Removal of tissues to stop a disease from happening. There is no problem/condition yet.

Preventive

Surgical removal of tissue. Involves removing diseased or severely damaged body parts. (Non functional)

Ablative

Restore use or improve appearance. May achieve both

Reconstructive

the aim is to reduce pain, control symptoms and improve quality of life when there is no chance of cure.

Palliative

this surgery is to replace a body part that no longer | works properly

Transplantation

must be done as soon as possible to save the person’s life or preserves the function of a body part.

Emergency surgery

is not urgent but must be done at some point for the sake of the person’s ongoing health or quality of life or because the person chooses to have an operation which may be helpful but is not necessarily essential

Elective

– presents a low risk of complications and fast recovery time. The person can usually go home the same day.

Minor surgery

such as surgery to the organs of the head, chest and abdomen. Examples of this type of surgery include organ transplant, removal of a brain tumor, and removal of a damaged kidney or open-heart surgery. The person will need to stay in the hospital for some time. The risk of complications may be high and the person will take a longer time to recover.

Major Surgery

Orthopaedic surgery

musculoskeletal system

Ocular surgery

eyes

Neurosurgery

brain and spinal cord

Cardiac surgery

heart and surrounding blood vessels

Surgical oncology

treats cancer

Surgical oncology

treats cancer

Bariatric surgery

treats obesity

ORNAP-PCS

Operating Room Nurses Association of the Philippines - Philippines College of Surgeons

OR NURSE QUALIFICATION

With at least 6 months experience as a staff nurse in a surgical ward. With KSA relevant to perioperative nursing practice. An active member of the ORNAP

DIFFERENT ROLES OF NURSES IN THE CARE OF SURGICAL CLIENTS

CLINICAL UNIT NURSE OPERATING ROOM NURSE NURSE ANESTHETIST PACU NURSE

Responsible for the safe care of clients during surgery

OPERATING ROOM NURSE

Responsible for the care of clients in the pre and postoperative period

CLINICAL UNIT NURSE

Assist the anesthesiologist, both responsible for the safe delivery of anesthesia

NURSE ANESTHETIST

Responsible for the care of clients in the immediate post anesthesia and postoperative period

PACU NURSE

CAN BE CATEGORIZED BY BROAD TECHNIQUE

SURGICAL APPROACH

TRADITIONAL APPROACH. THE SURGEON MAKES A LONG LARGE INCISION TO ACCESS THE INTESTINAL ORGANS.

OPEN SURGERY

THE SURGEON MAKES SEVERAL SMALL CUTS/INCISIONS INSTEAD OF A LARGE ONE. SLENDER SURGICAL INSTRUMENTS ARE PASSED THROUGH THESE INCISIONS. THIS IS A SPECIAL VIEWING TUBE FITTED WITH A LIGHT SO THE SURGEON CAN SEE THE INTERNAL ORGANS

KEYHOLE SURGERY

IS USED FOR DELICATE WORK ON VERY SMALL BODY STRUCTURES. USES DELICATE EQUIPMENT AND MICROSCOPES TO MAGNIFY THE ARE TO BE OPERATED ON.

MICROSUGERY

PHASES OF PERIOPERATIVE NURSING

o PRE-OPERATIVE o INTRAOPERATIVE o POST OPERATIVE

From the time the decision is made for a surgical intervention to the time patient is transferred on the operating room table.

PRE-OPERATIVE PHASE

WHAT ARE THE (16)THINGS NEEDED TO ASSES IN THE PREOPERATIVE PHASE

1. Identify obvious risk factors for surgery related complications 2. Assess Nutritional Status 3. Assess respi status 4. Cardiovascular status 5. Assess for reports and evidence of F/E Imbalance 6. Renal and Helatic Funct. 7. Examine clients record for endocrinw and metabolic problem 8. Immunologic and hematologic funct 9. Neurologic funct 10. Integ 11. Evaluate Medication history 12. Obtain history of drug and alchohol abuse 13. Assess for any prosthetics and implants 14. Client and family's knowledge 15. Consider psychosocial factors 16. Patient's spiritual and cultural beliefs

ASSESS CLIENTS W SPECIAL NEEDS

1. Ambulatory Surgical Patients 2. Age-Extreme Patients 3. Patients w disability 4. Patients w nutritional needs 5. Patients w diabetes 6. Pregnant Surgical Patients 7. Obese patients 8. Clients undergoing emergency

To identify hyper/hypokalemia

Serum K(Potassium)

To identify hyper/hyponatremia, dehydration and overhydration

Serum Na (Sodium)

To identify hyper/hypoglycemia

Glucose (FBS) Fasting blood sugar

Identify impaired liver,kidney function or excessive protein or tissue catabolism

BUN (blood urea nitrogen)

Identify acute or chronic renal disease

Creatinine

Determine presence and extent of anemia

Hemoglobin / Hematocrit

identify blood clotting dysfunction

Prothrombin time

to identify deficiency of coagulation factors

Partial Thromboplastin Time

to determine size and contour o the heart, lungs and major vessels

Chest x-ray

to determine the electrical activity of the heart

Electrocardiogram

NURSING DIAGNOSIS

1. Anxiety 2. Pain 3. Deficient knowledge

* A legal document * Guards the client against unmanned invasive procedures * Protects the health care facility and personnel

INFORMED CONSENT

is a child who has been granted the status of | adulthood by a court order or other formal arrangement.

emancipated minor

NURSES’ ROLE IN INFORMED CONSENT

- May witness the IC process between the physician and the patient - May not be delegated with the responsibility of obtaining an IC on behalf of the physician - May witness the signature of the patient on the consent form - However, in much the same way that the physician must discuss the medical information concerning the treatment or the procedure, a nurse also has an independent duty to inform the patient of nursing care and services rendered.

PREOPEARTIVE TEACHING

- Deep breathing, coughing exercise & incentive spirometry - Turning of extremity exercise. Mobility and active body movement. - Pain control/management

Purpose: to render the surgical site free from microorganisms, dirt, and skin oils

Preparing the skin

Mechanical Cleaning:

Bathing patient prior to surgery (antiseptic solution)

If the operation is in the distal portion clean from

2 inches

o Reduce the possibility of vomiting and aspiration during anesthesia o Reduce possibility of bowel obstruction o Prevent contamination from fecal material during intestinal or bowel surgery

Preparing the Gastrointestinal Tract: done the night prior to surgery

Preparing the Gastrointestinal Tract include:

1. Restricting food and fluids/NPO 2. Administration of enema as needed 3. Insertion of GI tubes when appropriate (NGT, Rectal tubes)

C. Preparing for Anesthesia: The Anesthesiologist / Nurse Anesthetist must:

1. Do pre-op visit, check CP clearance, neurological examination 2. Discuss type of anesthesia 3. Address fears concerning anesthesia

PREPARING CLIENT ON THE DAY OF THE SURGERY

✓ Check and carry out doctors order ✓ Ensure checking of vital signs, ID bands, skin prep as ordered, NPO status and urine output ✓ Remove jewelries, dentures, braces, nail polish, contact lens, make ups and underwear ✓ If wearing a hearing aid, notify OR nurse ✓ Continue to assess for anxiety/fear

WOUND CLOSURE TECHNIQUES

o SUTURES o STAPLES o ADHESIVE SKIN GLUE

➡ Sterile strands prepared from a collagen derived from healthy mammals ➡ Don’t require your doctor to remove them. This is because enzymes found in the tissues of your body naturally digest them ➡ Ex. Gut, Polydioxanone (PDS), Poliglecaprone (MONOCRYL), Polyglactin (Vicryl).

Absorbable suture

are strands of material that effectively resist enzymatic digestion or absorption of living tissues

Non-absorbable suture-

Surgical staple remover

Provides a fast and easy removal of all brands of surgical skin staples for versatile use scissor style

Used after a surgery or traumatic injury to bind together external or internal tissue

SURGICAL SKIN SEALANTS (SKIN GLUE)