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Concepts > Care of Surgical Patient > Flashcards

Care of Surgical Patient Flashcards

1
Q

Needed to be done Immediately; life threatening situation

A

Emergency

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2
Q

Preserve life, a body part, or function

A

Emergency

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3
Q

Example of emergency surgery

A

Gallbladder surgery, appendectomy, bowel upstruction, coronary bypass

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4
Q

Not an emergency; requires prompt intervention

A

Urgent

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5
Q

Within a reasonably short time frame—24-48 hours

A

Urgent

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6
Q

Preserve health

A

Urgent

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7
Q

Example of Urgent Surgery

A

Simple hernia repair,

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8
Q

Non-urgent, non-acute problem, not life threatening but surgery is preferred
treatment

A

Elective

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9
Q

Pre-planned

A

Elective

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10
Q

Patient’s choice; must have versus should have

A

Elective

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11
Q

Not critical to survival or function. Personal preference. Cosmetic.

A

Optional

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12
Q

to make or confirm diagnosis

A

Diagnostic Surgery

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13
Q

Biopsy, colonoscopy

A

Diagnostic Surgery

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14
Q

To remove diseased body part

A

Ablative Surgery

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15
Q

removal of limb, thyroidectomy, tonsilectomy

A

Ablative surgery

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16
Q

: To restore function to a traumatized or malfunctioning

tissue.

A

Restorative (reconstructive) Surgery

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17
Q

Facial reconstruction, skin grafts, post-mastectomy breast reconstructive.

A

Restorative surgery

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18
Q

To relieve or reduce intensity of an illness; is not curative. Relieve
symptoms without curing

A

Palliative surgery

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19
Q

Removal of mass, removal of bowel obstruction.

A

Palliative surgery

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20
Q

To restore function in congenital anomalies

A

Constructive surgery

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21
Q

To replace organs or structures that are diseased or malfunctioning.

A

Transplantation surgery

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22
Q

Two degrees of risk

A

Minor, major

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23
Q

Low risk to patient; fewer complications; often same day surgery

A

Minor Risk

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24
Q

High risk to patient; more complicated; increased blood loss; vital organ
involved; increased risk of post-operative complications.

A

Major Risk

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25
Q

Surgical settings

A

Ambulatory, Hospital

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26
Q

Advantages of Same Day Surgeries

A

Lower cost, less risk for hospital acquired infections, decrease in stress and anxiety, faster

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27
Q

Disadvantages of Same Day Surgeries

A

May encounter more complications, limited time for preoperative education, must social support

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28
Q

Inpatient surgeries are more complicated, emergency, urgent and some elective.
Decreasing length of stay is a priority now.

A

Hospital Setting

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29
Q

Preoperative Medical + Nursing Assessment

A

1) Identify patient risk factors
2) Collect data
3) Educate patient and family

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30
Q

CBC

A

Complete Blood Count

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31
Q

Surgical clinics, Doctor’s office, outpatient surgery in hospital.

A

Ambulatory Surgeries

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32
Q

UA

A

Urinalysis

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33
Q

BMP

A

Basic Metabolic Panel

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34
Q

Presurgical Testing

A

1) CBC
2) UA
3) BMP
4) Chest x-ray
5) EKG
6) Type +Cross Matching

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35
Q

Performed by MD, PA, NP. Identifies potential problems and establishes baseline. Patient must be cleared for OR, done in office or on admission.

A

History + Physical

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36
Q

Components of History + Physical

A

1) Respiratory Status
2) Cardiovascular Status
3) Renal Status
4) Musculoskeletal status
5) Neurological Status
6) Nutritional + Hydration Status

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37
Q

Urinalysis is used to identify…

A

Kidney Function

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38
Q

BMP looks at

A

Electrolytes (sodium, potassium, etc.)

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39
Q

Nursing Assessment

A

1) Current Problem
2) Vital Signs
3) Height + Weight
4) Allergies
5) Health Habits
6) Chronic Health Problems
7) Previous Surgery
8) Medications
9) Support System, sociocultural needs
10) Physical Assessment

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40
Q

-Mycins, potentiate muscle relaxants

A

Antibiotics

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41
Q

Increase bleeding time, problem with clotting, should be stopped several days before surgery.

A

Anticoagulants, Aspirins, NSAIDS

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42
Q

When used with anesthetics can cause hypotension

A

Antihypertensives

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43
Q

Loss of K. Hypokalemia will cause cardiac problems, arrhythmias

A

Diuretics

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44
Q

steroids—when stopped suddenly will cause CV collapse; Also

steroids are anti-inflammatory and will delay wound healing

A

Corticosteroids

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45
Q

potentiate narcotics and barbiturates which will decrease BP and
cause CNS depression

A

Tranquilizers

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46
Q

Nursing Diagnoses

A
  1. Knowledge Deficit:
  2. Fear R/T
  3. Powerlessness R/T
  4. Anticipatory Grieving R/T
  5. Anxiety R/T
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47
Q

Respiratory Equipment

A
  1. Incentive Spirometer

2. Positive Expiratory Pressure (PEP) Cough Support Device

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48
Q

Postoperative Exercises + Activities

A
  1. Anti-embolism stockings (TED’s)
  2. Sequential Compression Device (SCD’s)
  3. Leg exercises
  4. Turning in bed; OOB
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49
Q

to empty bladder; may return with one or may need one after if does
not void usually within 8-12 hours post op. When in place patient may still feel the urge to
urinate.

A

Foley Catheter

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50
Q

to keep stomach empty; rests the GI tract; attached to LIWS-low intermittent
wall suction. Placed in surgery or after. Irrigate only if ordered.

A

NG Tube

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51
Q

Postoperative Equipment

A

1) Foley Catheter
2) NG Tube
3) Drains
4) IV Access; PCA
5) Ventilator
6) CPM Machine, Abduction Pillow, Dressings, Ostomies

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52
Q

Knee surgery

A

CPM Machine

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53
Q

Hip Surgery

A

Abduction Pillow

54
Q

Ordered by anesthesiologist

Given at scheduled time, on call, or in the holding area

A

Preoperative Medications

55
Q

such as diazepam (Valium); midazolam (Versed); or lorazepam (Ativan) to
alleviate anxiety and decrease recall of events related to surgery

A

Sedatives

56
Q

such as atropine and glycopyrrolate (Robinul) to decrease pulmonary
and oral secretions and prevent laryngospasm

A

Anticholinergics

57
Q

such as morphine to facilitate patient sedation and relaxation and to
decrease the amount of anesthetic agent needed

A

Narcotic analgesics

58
Q

such as fentanyl citrate-droperidol (Innovar) to cause ageneral state of calmness and sleepiness

A

Neuroleptanalgesic agents

59
Q

such as cimetidine (Tagamet) and ranitidine

(Zantac), to decrease gastric acidity and volume

A

H2-histamine receptor antagonist

60
Q

Post medication administration safety:

A

Patient should be on bedrest, in bed or on stretcher, with siderails up, and safety
belt on prn

61
Q

IMMEDIATE PRE OP NURSING CARE NURSING RESPONSIBILITIES

A

A. Preoperative check List
B. Assess NPO Status and Vital Signs
C. Informed Consent – Physician is responsible for providing appropriate information

62
Q

Preoperative informed consent should include:

A
  • Nature and intention of the surgery
  • Name of the person performing the surgery
  • Risks, including tissue damage, disfigurement, or even death
  • Chances of success
  • Possible alternative measures
  • The right of the patient to refuse consent or later withdraw consent
63
Q

Nursing Responsibilities regarding informed consent

A

-Ensure that consent is signed
-Witness patient’s signature
-Nurse’s signature does not indicate that the patient is informed
-Surgeon must be contacted and requested to see the patient if the patient needs
any clarification of information.
-Consent must be signed before any preop medication is administered.
-Must call MD if pre-op medication has been given.

64
Q

Criteria for a Consent to be Valid

A
  1. Consent is voluntary
  2. Informed subject
  3. Competent subject—Legal age and mentally competent
65
Q

consent is signed by next of kin usually spouse, adult child, parent, sibling.

A

Incapable Adults

66
Q

Who signs for minor (under 18)?

A

Parent or legal Guardian

67
Q

consent is signed by next of kin usually spouse, adult child, parent, sibling.

A

Emergency Consent

68
Q

Blind patients can sign the consent with…

A

two witnesses

69
Q

Certain procedures require additional consents:

A

Blood Transfusion

70
Q

performs surgery, manages patient care before and after

A

Surgeon

71
Q

works under the supervision of the surgeon.
Responsibilities include: handling tissue, suturing, providing visualization of the
operative area, maintaining homeostasis

A

Registered Nurse First Assistant

72
Q

administers anesthesia and other drugs, monitors
patient’s response throughout procedure, manages any technical problems, intubates
patient.

A

Anesthesiologist or Anesthetist

73
Q

Has graduated from an accredited nurse anesthetist program,

passed exams to become a Certified Nurse Anesthetist.

A

Nurse Anesthetist

74
Q

RN who coordinates activities and environment in OR, is patient
advocate by assessing and monitoring the patient’s safety, monitoring surgical asepsis, is
responsible for counts, assists with patient positioning, preparing the patient’s skin,
managing surgical specimens, and documenting events.

A

Circulating RN

75
Q

RN, LPN, Surgical Technician—responsible for preparation of sterile
supplies, delivery of instruments, anticipate what instruments and supplies will be needed,
assists with final counts

A

Scrub Person

76
Q

Inhalation or Intravenous
Produces CNS depression, analgesia, relaxation, and reflex loss
Patients are not arousable, are unable to maintain breathing and require mechanical ventilation, and CV function may be impaired also

A

General Anesthesia

77
Q

4 stages of General Anesthesia

A

1) Beginning Anesthesia
2) Excitement
3) Surgical Anesthesia
4) Medullary Depression

78
Q

Local anesthetic injected around nerves
Patient is awake and aware of surroundings
Less systemic effect. Good for elderly, those with cardiac or respiratory problems,a patient who has recently eaten

A

Regional Anesthesia (blocks or spinal)

79
Q

Two Types of Regional Anesthesia

A

Epidural

Spinal

80
Q

Agent is injected into the epidural space that surrounds the duramater of the spinal cord.

A

Epidural Anesthesia

81
Q

Advantage of Epidural?

A

No headache

82
Q

Disadvantage of Epidural?

A

need more precise technical administration. Can be used postoperative also for pain control.

83
Q

Agent injected through the dura mater and into the
subarachnoid space surrounding the spinal cord.
Produces anesthesia to lower extremities, perineum, and lower abdomen. Side effects—headache and hypotension. Tx: lay flat and administer fluids.

A

Spinal Anesthesia

84
Q

Used alone or with regional anesthesia. Minimal depression of LOC., patient can maintain airway,
respond to commands. Uses IV narcotic and antianxiety drugs. Used in short term surgical procedures or diagnostic procedures (colonscopy). Continuous monitoring is required

A

Moderate Sedation/Analgesia (previously called Conscious sedation)

85
Q

Nursing Responsibilities in the Operating Room

A
  1. On-going assessment – physiologic, psychosocial, physical, ethical
  2. Physiological monitoring-vitals, telemetry, I+O, lab results, pulse ox.
  3. Minimize anxiety – psychological support
  4. Minimize risk for injury
  5. Patient Advocate
86
Q

Potential Inoperative Complications

A

1) Nausea + Vomiting
2) Anaphylaxis
3) Hypoxia
4) Hypothermia
5) Malignant Hyperthermia

87
Q

Inadequate ventilation due to airway occlusion, inadvertent intubation of
esophagus instead of trachea. Other causes are respiratory depression from
medications, aspiration of secretion or vomitus, the positioning of the patient on the table.
Brain damage occurs within minutes. Patient must be monitored carefully—O2 levels,
pulse ox, peripheral circulation.

A

Hypoxia

88
Q

-Intentionally done with bypass surgery. Unintentionally done
because of low room temperature, cold IV fluid, inhaling cold gases, open body cavity,
decreased muscle activity, age, medications. Re-warm gradually. Room temperature,
warm IV fluids, dry sheets. Monitor patient closely.

A

Hypothermia

89
Q

-A rare inherited MS disorder chemically induced by
anesthetic agents. ID patients at risk: bulky muscles, hx of MS cramps or weakness,
unexplained increase in temperature, and unexplained death of family member during OR
with increased temperature. Recognizing symptoms early and discontinuing anesthesia
and surgery are imperative.

A

Malignant Hyperthermia

90
Q

an acute allergic reaction to an antigen (e.g., a bee sting) to which the body has become hypersensitive. Life threatening.

A

Anaphylaxis

91
Q

Transferring a person to PACU (Steps)

A
  1. Patient transferred to PACU with anesthesiologist
  2. Report given to PACU nurse
  3. All pre-op orders cancelled – new orders must be written
92
Q

PACU stands for…

A

Post Anesthesia Care Unit

93
Q

Focus of Nursing Care in PACU

A
  1. Physiological monitoring
  2. Psychological support
  3. Environmental safety
  4. Comfort measures
94
Q

Respiratory Status

A

1) Airway Patency
2) Hypoventilation
3) Aspiration

95
Q

assess for return of gag reflex; look at positioning of tongue;
accumulation of secretions. Perform respiratory assessment including:

A

Airway Patency

96
Q

shallow respirations and decreased gas exchange R/T anesthesia,
narcotics, muscle relaxants, pain or obesity.

A

Hypoventialtion

97
Q

inhalation of gastric contents; nausea and vomiting.

A

Aspiration

98
Q

When assessing Cardiocascular status, we assess BP every _________ minutes and check for ________, _________, __________, _________ + ________ .

A

15 Minutes

Cardiac Rhythm, Skin Color,
Capillary Refill, All Pulses, Intake + Output.

99
Q

When assessing wound status, we check for….

A

Bleeding/Hemorrhaging/Shock, check linens underneath wound, circle drainage, reinforce as needed, assess tubes and drains.

100
Q

When assessing wound status post-op, we never…

A

change the dressing

101
Q

When assessing the Central Nervous System Status, we check for:

A
  1. LOC, responsiveness, and extremity movement and sensation
  2. Naloxone (Narcan)
  3. Atropine or Glycopyrrolate (Robinul) with Neostigmine
  4. Hypothermia
102
Q

Reverses Narcotics

A

Naloxone (Narcan)

103
Q

Reverses Muscle Relaxers

A

Atropine or Glycopyrrolate (Robinul) with Neostigmine

104
Q

Fluid imbalance can occur due to…

A

NPO (Nothing by mouth) status, fluid loss during surgery, wound drainage, surgical stress response.

105
Q

Assess + treat…

A

Pain

106
Q

Focus of Post Op Nursing Care for Hospitalized Patient

A
  1. Physiological monitoring
  2. Psychological support
  3. Comfort measures
  4. Support of family
  5. Mobilization
  6. Wound healing
  7. Discharge planning
107
Q

-incomplete expansion or collapse of alveoli resulting in poor gas exchange.

A

Atelectasis

108
Q

Treatment of Atelectasis:

A

Raise head of bed, C & DB every 1-2 hours, apply O2, T & P every 2 hours

109
Q

lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid. Inflammation may affect both lungs, one lung, or only certain lobes.

A

Pneumonia

110
Q

Treatment of Pneumonia:

A

Raise head of bed, C & DB every 1-2 hours, apply O2, T & P every 2 hours, administer antibiotics + hydration

111
Q

Pulmonary Embolism

A

a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg. May develop 5-10 days post op.

112
Q

Treatment of Pulmonary Embolism:

A

Notify MD, apply O2, raise head of bed

113
Q

an emergency condition in which severe blood or fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

A

Hypovolemic Shock/Hemorrhage

114
Q

Treatment of Hypovolemic Shock/Hemorrhage

A

Stop bleeding, replace blood volume (IV fluid and transfusion), O2, elevate legs

115
Q

Treatment of Thrombophlebitis/Venous Thrombosis:

A

anti-coagulants, TEDS, bedrest, do not massage

116
Q

Skin Prep Pre Op

A

Shave skin w/ electric razor, clean area with antimicrobial soap,

117
Q

GI Prep Pre Op

A

Helps to prevent aspiration, depends on the surgery, helps to prevent contamination further preventing infection

118
Q

Paralysis of intestinal smooth muscle

A

Paralytic ileus

119
Q

Treatment of Paralytic Ileus:

A

Insert nasogastric tube, increase activity

120
Q

Treatment of Constipation:

A

increase activity, administer stool softners, increase fluids and fiber

121
Q

a condition in which there is difficulty in emptying the bowels, usually associated with hardened feces.

A

Constipation

122
Q

How do we provide for a safe transfer?

A

Bed rails up, take all equipment, proper personnel there for transfer.

123
Q

Treatment of Urinary Retention

A

: measure urine after voiding, palpate suprapubic area, use bladder scanner to
assess amount of urine in bladder, urinary catheterization

124
Q

the inability to completely or partially empty the bladder.

A

Urinary Retention

125
Q

inflammation of a vein with blood clot formation inside the vein at the site of the inflammation

A

Thrombophlebitis/Venous Thrombosis

126
Q

Wound infection may not be present until post op days __-__ .

A

5-10

127
Q

Treatment of Wound Infection:

A

Use Aseptic Technique, Administer Antibiotics

128
Q

Treatment of Wound Dehisence + Evisceration:

A

cover with sterile towels soaked in sterile 0.9% normal saline, notify MD

129
Q

Care of wound and dressing, symptoms to report, medications, activities allowed and prohibited, dietary
restrictions or modifications, follow up care, answer any other questions.

A

DISCHARGE INSTRUCTIONS AND PLANNING

130
Q

anesthesia that affects a restricted area of the body.

A

Local Anesthesia

131
Q

CVP assesses…

A

Right ventricular function

132
Q

Swan Guaze assesses…

A

left ventricular function

Concepts (15 decks)

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