Ch.50 Care Of Surgical Patients Flashcards
Seriousness
Major: Extensive surgery can have high risks to patient
Minor : minimal surgery or alteration to the body , not so many risks to the individual
Table 50–1 classification of surgical procedures
Classified by seriousness urgency and purpose
Urgency
Elective: it is not necessary , it is the patient’s choice to do the surgery (wants to do it)
Urgent: it is done to prevent more major complications , it is necessary for the patients health
Emergency: it is crucial to have the surgery, it is life or death
Purpose:
Diagnostic : to further determine the condition of patients health, explore
Ablative: disease body part is removed or excised
Palliative : surgery to convey comfort not for cure
Reconstructive/ restorative : helps restore the function or the appearance of injured tissues
Procurement for translation: the harvesting of body organs to be put into another person’s body
Constructive : restores function of congenital abnormalities
Cosmetic : improves the appearance
Table 50–2 physical status classification of the American Society of anesthesiologist
How do anesthesiologist classify patient by their characteristics before surgery
P1 a normal healthy patient no physiological biological or organic disturbances
P2 a patient with mild stomach disease such as cardiovascular disease with minimal restriction on activity
P3 patient with severe systemic disease hypertension obesity or diabetes mellitus
P4 for a patient with severe systemic disease that is a constant threat to life
such as :
cardiovascular pulmonary disease Limits activity
severe diabetes with complications
history of MI
angina pectoris
or poorly controlled hypertension
P5 a patient who is at the point of death who is not expected to survive without the operation
P6 a patient declared brain-dead who’s organs are being removed for donor purpose
Table 50–3 medical conditions that increase risk for surgery
Low platelets or hemophilia
increases hemorrhage during and after surgery
Diabetes mellitus
Wound healing alterations
Stress of surgery causes hyperglycemia
More at Risk for infection
Myocardial infarction heart failure peripheral vascular disease -surgery causes stress and myocardium function Increased cardiac output anesthetics depressed cardiac function
Obstructive sleep apnea
Increase risk of airway obstruction after surgery
Upper respiratory infection
The increased risk of respiratory complications
Liver disease
Alters medication metabolism and elimination
increases clotting time
Seaver chronic respiratory disease emphysema bronchitis asthma
Risk for increased hypo ventilation
Body unable to effectively handle acid base imbalance
AIDS leukemia bone marrow depression use of chemotherapeutic drugs-
Increase risk for infection
Wound healing alteration
ABUSE OF STREET DRUGS - affects healing
Chronic pain
Increases tolerance increases dose necessary
50–4 physiological factors places the older adult risk during surgery
Why does the older adults have more of a risk during surgery?
Cardiovascular
changes in myocardial involves decreased cardiac output and surgery puts stress on the heart
Stiff of arterial walls and reduction and stimulation of energy to the heart
-May experience hemorrhage and rise in blood pressure
How can the nurse to help this patient?
By maintaining adequate fluid and ensuring that blood pressure is adequate to meet circulatory demands
Small Arteries are partially blocked by calcium and cholesterol deposits and arterial walls thicke
is prone to clot formation in lower extremities
What intervention can the nurse do to prevent this? Teach patient leg exercises applying stockings compression devices Administration of anticoagulant meds dietary considerations
Integumentary system
Older adults and loses elasticity and thining of skin
patient is prone to tissue damage
of pressure ulcers and skin tears
Pulmonary system
Decreased respiratory muscle strength and cough reflux
Risk for atelectasis
Reduced movement of diaphragm
Increase of residual capacity
Doesn’t allow for new air to be brought into lungs
Lung tissues become stiff and more air spaces develop:
Blood oxygenation is reduced
GI system
Gastric emptying slows down
Increases indigestion and risk for reflux ( gastric contents to be brought up through esophagus)
Position patient into a semi or high fowlers position
Small feelings
Renal system
Renal function is decreased -> may lead to shock
Blood flow to kidneys decreased -> may alter fluid and electrolyte balance
Reduced glomerular filtration rate and excretion capabilities
Unable to excrete medications effectively
Decreased bladder capacity
Risk for urgency , frequency , uti , in continence
Neurological system
Sensory loss
Unable to sense pain and increases the inability to tell if a surgical complication is happening
Inability to diagnose infection correctly
Decreased reaction time
Confusion and delirium increase the patient for falls
Diagnostic values
Coagulation
Pt: 11-12.5
Inr: 0.76-1.27
Aptt: 30-40
Bun:10-20mg/dL
Serum creatinine :
Men: 0.6-1.2
Women : 0.5-1.1
