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Concepts Exam 3 > Care of the Surgical Patient > Flashcards

Care of the Surgical Patient Flashcards

1
Q

What are the different types of urgencies

A

Elective (you chose to do it yourself)

Urgent

Emergent/stat

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2
Q

What is a diagnostic surgery?

A

Like a biopsy, diagnostic laparoscopy/ exploratory laparotomy

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3
Q

What is an ablative surgery?

A

Removing a diseased body part

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4
Q

What is a palliative surgery

A

Relieve/reduce intensity of a disease

Not curative

Like a debridement

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5
Q

What is a reconstructive surgery?

A

Restore function/improve self-concept

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6
Q

What is a transplantation surgery?

A

Replace organs

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7
Q

What is a constructive surgery?

A

Restore function to congenital abnormality like a cleft palette

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8
Q

What are common risks of surgery?

A

Surgical site infection

Clotting

Blood loss/hemorrhage

Pneumonia

Hypoglycemia

Malignant hyperthermia

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9
Q

What is perioperative?

A

Begins with decision to have surgery, last until patient is transferred to operating room or procedural bed

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10
Q

What is intraoperative?

A

Begins when the patient is transferred to the OR bed until transferred to the post anesthesia care unit (PACU)

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11
Q

What is postoperative?

A

Begins from admission to the PACU or other recovery area to complete recovery from surgery and last follow up healthcare provider visit

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12
Q

What do you do in the preop phase?

A

Provider obtains informed a consent

NPO

Assessment: vital signs, review of medical/surgical history, allergies, signs of infection, skin breakdown

Lab draw

IV access

Teaching begins in this phase

Advance directives/DNR

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13
Q

What are advance directives?

A

Living will

Durable power of attorney for healthcare

DNR

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14
Q

What medications are usually ok to take on the day of surgery?

A

Blood pressure pills

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15
Q

What pills are not ok to take on the day of surgery

A

Diabetic pills because there NPO, and can’t eat

Aspirin or Plavix, any blood thinner

Antipsychotic drugs especially the MOA inhibitors

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16
Q

What is the safety check for surgery?

A

Correct patient

Correct procedure/surgery

Correct site

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17
Q

What is the minimum fasting period for a heavy meal?

A

8 hours

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18
Q

What is the minimum fasting period for a light meal? (Ex toast)

A

6 hours

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19
Q

Minimum fasting period for non-human milk/infant formula?

Breast milk?

A

6 hours

Breast milk: 4 hours

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20
Q

Minimum fasting for clear fluids.

A

2 hours

21
Q

How is a diuretic a surgical risk?

A

Electrolyte imbalances, respiratory depression from anesthesia

22
Q

How is a tranquilizer a surgical risk?

A

Increases hypotensive effects of anesthetic agents

23
Q

How is an adrenal steroid a surgical risk?

A

Abrupt withdrawal may cause cardiovascular collapse

24
Q

How is an antibiotic in the mycin group is surgical risk?

A

Respiratory paralysis when combined with certain muscle relaxants

25
Q

What are the usual pre-surgical screening tests

A

Chest x-ray

Electrocardiography

Complete white blood cell count (CBC)

Electrolyte levels (BMP)

Urinalysis/UPT

26
Q

When do you use moderate/analgesia “conscious sedation”?

A

Use for short term, minimally invasive procedures

27
Q

What is regional anesthesia?

A

Anesthetic agent injected near a nerve or nerve pathway or around operative site

“Nerve/tap block”

28
Q

When do we use topical or local anesthesia?

A

Used on mucous membranes, open skin, wounds, burns

29
Q

What are different types of regional anesthesia?

A

Peripheral nerve blocks

Spinal anesthesia

Epidural anesthesia

30
Q

What is peripheral nerve blocks?

A

Decreases sensation/movement, will still feel pressure, but no pain, may be unable to move extremities

31
Q

What does a spinal (subarachnoid) anesthesia numb?

A

Lower abdomen/perineum/legs

32
Q

What part of the body does an epidural work on?

A

Lumbar, thoracic, cervical (chest, abdomen, pelvis, legs)

33
Q

What is the pro of a regional anesthesia?

A

Less bowel dysfunction

34
Q

How would you use a topical lidocaine?

A

If skin is intact: spray/spread the anesthetic

May come in a patch form

35
Q

What are the signs of a lidocaine toxicity?

A

Facial tingling, oral numbness, restlessness, vertigo, tinnitus, slurred speech, seizures

36
Q

What are the three phases of general anesthesia?

A

Induction

Maintenance

Emergence

37
Q

What is the induction phase?

A

From administration of anesthesia to ready for incision

38
Q

What is the maintenance phase of anesthesia?

A

From the incision to near complete of procedure

mostly gas

39
Q

What is the emergence phase of general anesthesia?

A

Starts with patient emerges from anesthesia and is ready to leave operating room

Reversal drugs may be given if needed

40
Q

What does a patient experience while under general anesthesia?

A

Loss of consciousness

Amnesia

Analgesia

Relaxed skeletal muscles (temporary paralysis- diaphragm)

Depressed reflexes

Patient is not breathing on their own, but with a breathing tube (endotracheal tube) and a ventilator

41
Q

What are the two main drugs for moderate sedation?

A

Midazolam (versed)

Propofol (Diprivan)

42
Q

What is the nursing role during intraoperative?

A

Advocate for patient

Patient positioning: safety, skin injury, nerve injury

Maintaining sterile field

Performance/participating in the incisional timeout

Performing the surgical count

Never events: wrong surgery/site events and retained surgical items

43
Q

What is the intraoperative phases?

A

Timeouts
-Everyone does it

Positioning of patient
-Body alignment and safely applying equipment with regards to skin integrity

Fluid balance
-Nurse keeps up with all intake and output, including blood loss

44
Q

What does the patient have to be able to do before the nurse can take out the ET tube?

A

Can the patient follow commands. Example “can you squeeze my fingers?”

Can they raise there head up off the pillow for more than 10 seconds

Respiratory gives them a NIF

45
Q

What kind of restraints are used for surgery?

A

Bed rails may be up during transport and in PACU

Straps are placed on patient during surgery to prevent falling from OR table

Padded restraints may be appropriate for patients in emergence delirium for patient safety

Young patients, especially men under 40 can be combative on wake up

46
Q

Where would you take a patient’s temperature while they’re in postop?

A

Tympanic

47
Q

How often do we do postop assessments and interventions?

A

Every 10 to 15 minutes

48
Q

What are the postop assessments and interventions?

A

Respiratory status
- Airway and pulse ox

Cardiovascular status
-Blood pressure

Temperature

Central nervous system status
-Level of alertness, movement, shivering

Fluid status

Wound status

G.I. status
-Nausea and vomiting

General condition

Concepts Exam 3 (6 decks)

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