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93207 Foundations of Nursing Practice 2A > Care of the Surgical Patient (Perioperative Care) > Flashcards

Care of the Surgical Patient (Perioperative Care) Flashcards

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1
Q

What are the two categories of surgery in NSW?

A

1) Elective = Surgery that is non-urgent, not life threatening, and can wait longer than 24 hrs, which is booked in advance e.g., cataract surgery; joint replacement.

2) Emergency surgery = Surgery that needs to be performed within 24-hours and is immediately life threatening; if delayed will compromise pt safety. E.g., appendectomy; hip fracture surgery; coronary bypass surgery.

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2
Q

What are the 7 aspects involved in perioperative preparation?

A

1) Perioperative assessment
2) Patient education
3) Preoperative testing
4) Medication management
5) Preoperative instructions
6) Emotional support
7) Preoperative checklist

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3
Q

What is involved in perioperative assessment?

[7 aspects of perioperative preparation]

A

Thorough evaluation of…
- Patient medical history
- Current health status, and
- Any pre-existing condition that may impact the surgery

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4
Q

What is involved in patient education?

[7 aspects of perioperative preparation]

A

Providing information to the patient about…
- The surgical procedure
- What to expect before, during, and after surgery,
- Potential risks and complications
- Instructions for perioperative preparation e.g., does patient need to be fasting or is there any medications need to be given pre surgery?

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5
Q

What is involved in perioperative testing?

[7 aspects of perioperative preparation]

A

Ordering and reviewing necessary tests
- E.g., blood test done or some imaging studies (X ray or MRI) or some other diagnosis evaluations, to assess the patient overall health status and ensure they’re ready for surgery

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6
Q

What is involved in medication management?

[7 aspects of perioperative preparation]

A

Reviewing patients current medication, adjusting or discontinuing
- This minimises the risk of complications such as bleeding or drug interaction
- E.g., Patients that are on Warfarin need to discontinue before surgery to avoid bleed (most common complication)

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7
Q

What is involved in perioperative instructions?

[7 aspects of perioperative preparation]

A

Detailed instructions to patients about…
- Fasting requirements
- Medication restrictions
- Hygiene practice e.g., some patients need to shower with special antibacterial soap to prepare for their surgery
- Arriving time for the day of the surgery

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8
Q

What is involved in emotion support?

[7 aspects of perioperative preparation]

A

Addressing patients emotions, needs and concerns relating to the surgery
- Providing reassurance
- Answering questions
- Offering support and encouragement

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9
Q

What is involved in perioperative checklist?

[7 aspects of perioperative preparation]

A

Verify all necessary perioperative preparation and assessments have been completed and documented for example…
- Does patient have an ID band on?
- Does patient have any allergies?
- Are they fasting?
- Has any pre-medication given?

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10
Q

What are the three steps to surgical site preparation?

A

1) Skin preparation - shaving/clipping hair
2) Skin cleaning - 2%/4% alcoholic chlorhexidine, cetrimide, iodine 1% in alcohol 70%.
3) Draping surgical site

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11
Q

What does NBM stand for, mean, and in which circumstance is it usually applied in?

A

Nil by mouth - not allowed to consume any food or drinks orally. It’s a medical instruction often given before surgeries or medical procedures.

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12
Q

What is the benefit of being NBM before a surgery?

A

It prevents complications such as aspiration (accidentally inhaling food or liquid into the lungs), particularly when a patient is under anesthesia or undergoing procedures that require an empty stomach. It helps reduce the risk of vomiting or regurgitation during medical interventions, which could lead to serious respiratory issues.

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13
Q

The following are involved in…?

  • Fasting from solid food and fluids
  • Enteral Tube Feeding
  • Oral Medications
  • Breast Feeding
A

Perioperative airway preparation.

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14
Q

What is the ASA score?

A

ASA = American Society of Anaesthesiologists assessment of a patient’s overall health before surgery or medical procedures.

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15
Q

How many ASA scores are there and what do they mean?

A

There are 6 classifications:

  • ASA Class I: A normal healthy patient

ASA Class II: A patient with mild systemic disease

ASA Class III: A patient with severe systemic disease limiting activity but not incapacitating

ASA Class IV: A patient with incapacitating systemic disease that is a constant threat to life

ASA Class V: An extremely ill patient who is not expected to live 24 hours with or without an operation

ASA Class VI: A declared brain-dead patient whose organs are being removed for donor purposes.

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16
Q

What are the two types of liquid feedings and what do they mean?

A

1) Enteral nutrition when you have food directly into the stomach or small bowel.

2) Parenteral nutrition when you have food directly into a vein (PN).

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17
Q

What is a side effect?

A

An unintended or undesirable effect of a drug, medication, medical treatment, or intervention that occurs in addition to the desired therapeutic effect.

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18
Q

What ASA score is the following:

A patient with severe systemic disease limiting activity but not incapacitating

A

ASA 3

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19
Q

What ASA score is the following:

A patient with incapacitating systemic disease that is a constant threat to life

A

ASA 4

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20
Q

What ASA score is the following:

An extremely ill patient who is not expected to live 24 hours with or without an operation

A

ASA 5

21
Q

What ASA score is the following:

A patient with mild systemic disease

A

ASA 2

22
Q

What is PACU?

A

Post Anaesthetic Care Unit.

23
Q

What are some risks in the Post Anaesthetic Care Unit?

A
  • Nausea and vomiting
  • Respiratory complications
  • Postoperative pain management
  • Emergence delirium
  • Surgical complications
  • Hypothermia
24
Q

What is hypothermia?

A

When the body loses heat faster than it can produce it, causing the body temperature to drop below normal.

25
Q

Why is hypothermia a risk in surgery?

A

Anaesthesia and exposure to the cold operating room environment can increase the risk of hypothermia. It can impair wound healing, prolong the recovery and increase the risk of surgical site infection.

26
Q

What is delirium?

A

A condition in which there is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment (disoriented).

27
Q

What is emergence delirium?

A

A condition that happens when someone wakes up from anaesthesia after surgery where they experience confusion, agitation, or hallucinations as they’re coming out of anaesthesia.

28
Q

What is dehydration?

A

When your body loses more fluids than it takes in.

29
Q

The following are known as what..?

Sodium, potassium, calcium, chloride, bicarbonate, magnesium, and phosphate.

A

Electrolytes

30
Q

How many electrolytes are there and which are the most important ones?

A

There are several electrolytes but the most important ones are:

Sodium, potassium, calcium, chloride, bicarbonate, magnesium, and phosphate.

31
Q

Why are electrolytes important?

A

Electrolytes are important because they help regulate many essential functions in the body.

32
Q

The following is called what..?

Disruptions in the levels of minerals, called electrolytes. When the levels of electrolytes become too high or too low, it is called an __________.

A

Electrolyte imbalance.

33
Q

The following is known as..?

When foreign objects, food, or fluids enter the airways and lungs instead of the digestive tract (stomach) during swallowing.

A

Aspiration

34
Q

Are all patients the same?
[select one answer]

  • No
  • Yes
  • Both yes and no
A

Both yes and no.

Because each patient requires skilled and competent care that is delivered with the standards expected but everyone is unique individuals just like you so their needs are different.

35
Q

What does pulmonary mean?

A

Issues pertaining to the lungs.

36
Q

Fill in the missing gaps:

A
37
Q

What are the three phases of the surgical journey?

A
  1. Preoperative
  2. Intraoperative
  3. Post-operative
38
Q

What is the goal of preoperative assessment?

A

The goal of preoperative assessment is to identify any risk factors and plan care to ensure the patient’s safety during their surgical journey

39
Q

List the patient assessments performed during the preoperative phase of the patients surgical journey.

A
  1. Past health history including current medications, comorbidities, and allergies
  2. Physical assessment (A-H)
  3. Review of laboratory and diagnostic tests
  4. Nutritional status
  5. Fluid and electrolyte status
  6. Patient education
  7. Discharge planning
40
Q

True or false: Bowel prepartion is required for all patients undergoing adbominal surgery.

A

False

41
Q

True or false: Elderly patients have increased risk of changes to their fluid and electrolyte status when taking a bowel preparation?

A

True

42
Q

What is a manual bowel preparation?

A

Manual Bowel Preparation (MBP), or bowel prep, is the process of removing faeces from the colon prior to a medical or surgical procedure.

43
Q

What are some postoperative complications in abdominal surgery?

A

o Pain
o Acute confusion
o Nausea and vomiting
o Fever
o Haemorrhage
o Infection
o Thromboembolism
o Complications of bowel surgery.

44
Q

What is the role of a comprehensive patient history?

A

The overall goal of the preoperative assessments is to identify any risk factors and plan care to ensure the patient’s safety during their surgical journey.

45
Q

Why is it important to undertake a comprehensive physical examination of the preoperative patient?

A

A comprehensive A-H assessment is required to establish baseline data related to the patient’s physical functioning and to identify any risk factors such as smoking status, cardiovascular function and level of neurological functioning as examples.

46
Q

Why is it important to assess the patients nutritional status prior to surgery?

A

Patients who are malnourished are at increased risk for skin breakdown such pressure injuries and skin tears intraoperatively and in the postoperative period. They are also at increased risk for delay wound healing and infection.

47
Q

Why is it important to monitor the patients fluid and electrolyte status?

A

It is a nurse’s responsibility to ensure that patients are assessed on a continual basis to ensure that their hydration needs are met. Fluid imbalance can arise from a number of causes and can have detrimental effects on body function. Nurses, therefore, need to have a sound understanding of pathophysiological principles of hypovolaemia, normovolemia, hypervolaemia and fluid shifting.

48
Q

What are the steps to engage in effective preoperative education?

A
  1. Keep it simple: provide information that the patient needs to promote their safety, comfort, and compliance: Avoid overload, want to make sure they follow the directions for the really important items. Teach in small amounts. Repeat. Reinforce. Return demonstrations.
  2. Assess their readiness to learn: anxiety may prevent readiness.
  3. Focus on information to prevent complications: Familiarize them with what is going to happen, include activities that will help them heal and activities that will prevent complications.
49
Q

What is a primary concern when using a bowel preparation?

A

The patient may become dehydrated and experience hypovolaemia, and fluid shifting.

93207 Foundations of Nursing Practice 2A (5 decks)

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