Care of the Surgical Patient Flashcards
preoperative phase
from the decision of surgery to transfer into the operating room
Intraoperative phase
from transfer to the operating room to admission to the PACU
postoperative phase
starts at admission to the PACU and ends when completely recovered from surgery.
Emergency surgery
needed to be done immediately; life threatening situation
urgent
not an emergency; requires prompt intervention 24-48 hours
elective
non urgent, non acute problem, not life threatening but surgery is preferred treatment
optional
not critical to survival or function
diagnostic
to make or confirm a diagnosis
ablative
to remove a diseased body part
restorative
to restore function to a traumatized or malfunctioning tissue
palliative
to relieve or reduce intensity of an illness; is not curative
constructive
to restore function in congenital anomalies Ex. cleft palate
transplantation
to replace organs or structures that are diseased or malfunctioning.
Minor degree of risk
low risk to patient; fewer complications; often same day surgery
Major degree of risk
high risk to patient; more complicated; increased blood loss; vital organs involved; increased risk of post operative complications
What are some advantages of same day surgery?
Same day procedures-cheaper
less stress
less risk of HAI’sq
What are some disadvantages of same day surgeries
need more knowledge base & proper education
baseline info
limited activity at home and need more social support
What are some components of pre-surgical testing?
CBC, Basic metabolic panel, chest X-Ray, EKG/ECG,
What information would be included in a current problem nursing assessment?
What are they having surgery on
What information would be included in a vital signs nursing assessment
VITALS
Antibiotics
mycins–potentiate MS relaxants
Anticoagulants
Increase bleeding time, problem with cloting, should be stopped several days prior to surgery
Aspirin NSAIDS
same as anticoagulants
Antihypertensives
When used with anesthetics can cause hypotension
Diuretics
Loss of K+ . Hypokalemia will cause cardiac problems and arrhythmia. (getting rid of excess water)
Corticosteroids
Steroids–when stopped suddenly will cause CV collapse; also anti-inflammatory and will delay wound healing.
Tranquilizers
potentiate narcotics and barbiiturates which will decrease BP and cause CNS depresssion
Support system
sociocultural needs
Sedatives
diazepam (Valium); midazolam (versed), lorazepam (Ativan) to alleviate anxiety and decrease recall of events related to surgery
Anticholinergics
Atropine and Glycopyrrolate (Robinul) decrease pulmonary/oral secretions and prevent laryngospasm
Narcotic Analgesics
Morphine to facilitate patient sedation and relaxation and to decrease the amount of anesthetic agent needed.
Neuroleptanalgesic agents
fentanyl citrate-droperidol (Innovar) cause a general state of calmness and sleepiness
H2-histamine receptor antagonist
cimetidine (Tagamet) and ranitidine (zantac) to decrease gastic acidity and volume
General anesthesia
Inhalation or Intravenous–produces CNS depression, analgesia, relaxation and reflex loss.
Patients are not arousable, are unable to maintain breathing and require mechanical ventilation. Cardiovascular function may be impaired.
General Anesthesia
Beginning stage of anesthesia
initial feeling of detachment as the client is receiving the medication and is starting to work on the body.
Excitement stage of anesthesia
the person is excited and may be taking, crying or shouting
surgical anesthessia
the patient is unconscious and still the medication is doing what it is suppossed to do.
medullary depression
too much anesthesia has been administered or it is being broken down differently in the body.
Regional Anesthesia
Local anesthetic injected around nerves
Patient is awake and aware of surroundings. This has a less systemic effect. it is good for the elderly and those with cardiac and respiratory problems.
regional anesthesia
epidural anesthesia
agent is injected into the epidural space that surrpounds the dura mater of the spinal cord.
what is an advantage of epidural anesthesia
no headache
what are some disadvantages of an epidural
need more precise technical administration. Can be used post operative also for pain control.
spinal anethesia
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 are headache and hypotension
spinal anesthesia.
Hypoxia
inadequate ventilation due to airway occlusion, anadvertent intubation of esophagus instead of trachea.
What are some causes of respiratory depression
medications, aspiration of secretion or vomitus, the positioning of the patient on the table.
Hypoxia can cause
brain damage in minutes-patient must be monitored carefully-O2 levels, pulse ox, peripheral circulation.
how is Hypothermia intenionally cuased
bypass surgery
how is hypothermia unintentionally caused
low room temp, cold IV fluids, inhaling cold gases, open body cavity, decreased muscle activity, age, medications,
How do you rewarm a patient with hypothermia
graduallly. Room temperature, warm IV fluids, dry sheets. Monitor patient slowly.
