Care of Surgical Pts. - EX4 Flashcards by Ashley Maley

How are surgeries classified?

Based on:
Seriousness
Urgency
Purpose

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What are the levels of seriousness

Major + Minor

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What are the categories of urgency

Elective, Emergent, Urgent

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Classifications of surgery

DIagnostic, Ablative, Palliative, Reconstructive or Restorative, Constructive, Cosmetic

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What is considered a major surgery

extensive reconstruction/alteration in body parts; poses great risk to well being

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What is considered a minor surgery

involves minimal alteration in body parts; designed to correct deformities; minimal risk to well being

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What is considered an elective surgery

performed in basis of patient’s choice; is not essential and is not always necessary ofr health

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What is considered an emergent surgery

must be done immediately to save life or preserve function of body part

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What is considered an urgent surgery

necessary for patient’s heath; prevents development of additional problems

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define diagnostic

surgical exploration performs to confirm diagnosis; often involves removal of tissue for further diagnostic testing

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define ablative

excision/removal of diseased body part

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define palliative

relieves or reduces intensity of disease symptoms; does not produce cure

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define reconstructive

restores function or appearance to traumatized or malfunctioning tissues

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define constructive

resotres function to lost or reduced as result of congenital anomalies

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define cosmetic

performed to improve person appearance

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What is the difference between laparoscopic or a laparotomy

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What are some surgical risk factors

increase in WBCs
very young or old d/t fraily status
nutrition - vitamin A, C and Zinc
obese (bad nutrition - lack of protein and vits
obstructive sleep apnea - careful screening important
hypovolemic
PONV
smoking
immunosuppression
fluid/electrolyte imbalance

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What are preoperative assessments

patient’s expectations of surgery and recovery
nursing history
medical history
surgical history
risk factor knowledge
medications
allergies
smoking habits/alcohol
pregnancy
pain
emotional health

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What are the preop labs

BMP
CBC
Clotting studies
LFTs
CXR
ECG

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What are the normal lab values of BMP

K+ 3.5-5.1 mEq/L
Glucose<120mg/dL
BUN 10-20 mg/dL
Creatinine 0.5-1.2
WBC 3.7-11 K/uL

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What do BMP values indicate?

cardiac and hemodynamic stability, kidney function, and drug elimination, infection

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What are the normal lab values of CBC

Hgb 12-16 g/dL (F) or 13-18 g/dL (M)
Hct 36-48% (F) or 40-54% (M)

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What do CBC lab values indictate

volume status,
O2 carrying capacity,
and hemodynamic stability

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What are the normal lab values of clotting studies

Platelets 150-300 K/uL

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what doe clotting studies indicate

liver function and possible bleeding difficulties

What are the normal lab values of LFTs

AST < 48 units/L ALT < 55 units/L

what doe LFT lab values indicate

drug metabolism, clotting

What are the normal lab findings of CXR

clear lungs, no cardiomyopathy, no atelectasis

What do CXR values indicate

ID potential significant risks for complications

What are the normal lab findings of ECG

NSR, no concerning dysrhythmias, ischemia, or underlying cardiac disease

What do ECG values indicate

ID potentially significant risks for complication

What is important in preoperative education

NPO status prior to procedure Routines to stop/start procedure length of stay when to call/follow up Med when to stop and which to continue

Who explains the procedure, risks, benefits, alternatives, and prognosis if not surgery?

The provider

Who obtains consent for anesthesia

Anesthesiologist or CRNA

who obtains consent for surgical procedures

surgeon

who obtains consent for blood products

surgeon

What is the role of the RN during informed consent

witness that informed consent was obtained and confirm with pt questions were answered

What is involved in surgical prep

minimize risk for surgical site infection: maintain normal fluid and elyte balance:

How do you minimize risk for surgical site infection

skin asepsis antibiotics clipping instead of shaving hair

How do you maintain normal fluid and elyte balance

NPO - fasting, no chewing gum parenteral fluid administration large gauge PIV

What is the surgical prep immediately before surgery

prep hair, safeguard valuables prepare bowel and bladder vital signs prevention of DVT preop meds documentation/hand off site marking

Intraoperative phase includes

Time- out verify right pt, procedure, site, side

When is a time out performed

immediately prior to starting procedure

What is the purpose of a time out

reconcile any discrepancies among team

What does a circulating nurse do

management of pt care, skin prep, counts, movement

What does a scrub nurse and surgery technician do

assist surgeon knows the instruments passes instruments maintain sterile field

What are the types of anesthesia

general regional local moderate

define general anesthesia

unconscious - loses all reflexes , can be done through IV

general anesthesia risks

hypotension, changes in heart rate/rhythm, lowered temp, resp depression, emergence delirium

define regional anesthesia

loss of sensation in an area of body by anesthetizing sensory pathways ; along a nerve on the pathway of spinal cord

side effects of regional anesthesia

respiratory paralysis low BP

define local anesthesia

loss of sensation at desired site used in ambulatory surgery

what are patients at risk for with local anesthesia?

drug interactions and allergic reactions

define moderate sedation

IV moderate sedation used routinely for short term surgical, diagnostic, and therapeutic procedures that only require a depressed level of consciousness

risks of moderate sedation

aspiration, hypoxemia, respiratory depression, can become over sedated and lose ability to protect and maintain airway

what does the postoperative phase involve

begins when leaving OR too the PACU Q15 of: VS Resp and CV Neuro Effects of anesthesia Fluid status pain management temp control

postoperative phase 1 begins when

(immediate recovery)

postoperative phase 2

(intermediate recovery)

postoperative phase 3

(convalescence)

priority concepts of surgery?

Oxygenation Perfusion Fluid Volume Balance Pain INfection Control Mobility Safety Coping

what is Intraoperative Malignant Hyperthermia

severe reaction to certain anesthetic, inherited or genetic defect

IMH s/sx

tachypnea, hypercapnia, high fever, muscle rigidity, spasms, tachycardia , hyperkalemia, muslce breakdown onset 35mins to 2 hours from anesthetic induction

IMH intervention

dantrolene and cooling

what are early signs Postoperative Hemorrhage

resltess, increased HR and RR

what are late signs of postoperative hemorrhage

lethargic, rapid decrease in HR, RR, BP, SpO2

Interventions for postoperative hemorrhage

notify provider STAT, prepare for immediate transfer to OR