Chap 30: Perioperative nsg

Question 1

Preoperative Phase

Answer 1

Period when the surgeon and pt decide surgery is necessary and will take place. Ends when pt is transferred to OR bed or procedure bed.

Question 2

Intraoperative Phase

Answer 2

Begins when pt is transferred to OR bed and ends when pt is transferred to recovery area.

Question 3

Postoperative Phase

Answer 3

From admission to the recovery area, to complete recovery and the last f/u physician visit.

Question 4

Elective Surgery

Answer 4

Non-urgent and does not have to be done immediately. Preplanned and based on the pt’s choice and availability of scheduling for the pt, surgeon and facility.

Question 5

Emergency Surgery

Answer 5

Must be done immediately to preserve life, a body part or function.

Question 6

Urgent Surgery

Answer 6

Must be done within a reasonable short time but is not an emergency.

Question 7

Optional Surgery

Answer 7

Is not critical to survival or function.

Question 8

3 Phases of Surgery

Answer 8

Preoperative, intraoperative, postoperative

Question 9

Classifications of Surgery are based on

Answer 9

Urgency, degree of risk and purpose

Question 10

Classifications based on urgency

Answer 10

Elective, urgent, emergency and optional

Question 11

Classifications based on degree of risk

Answer 11

Major and minor

Question 12

Major Surgery

Answer 12

May be elective, urgent or emergency. Done to preserve life, remove or repair a body part, restore function improve or maintain health.
(e.g.) Cholecystectomy, amputation

Question 13

Minor Surgery

Answer 13

Is primarily elective. May be used to remove skin lesions or correct deformities.
(e.g.) Removal of warts, cataract extraction

Question 14

Classifications based on purpose

Answer 14

Diagnostic, ablative, palliative, reconstructive, transplantation and constructive.

Question 15

Diagnostic Surgery

Answer 15

To make or confirm dx.

(e.g.) Breast biopsy

Question 16

Ablative Surgery

Answer 16

To remove diseased body part.

(e.g.) Apendectomy

Question 17

Palliative Surgery

Answer 17

To relieve or reduce intensity of an illness but it is not curative.
(e.g.) Balloon angioplasties

Question 18

Reconstructive Surgery

Answer 18

To restore function traumatized or malfunctioning tissue.

(e.g.) Plastic surgery

Question 19

Transplantation Surgery

Answer 19

To replace organs that are diseased or malfunctioning.

(e.g.) Kidney transplant

Question 20

Constructive Surgery

Answer 20

To restore function in congenital anomalies.

(e.g.) Cleft palate repair

Question 21

Types of Anesthesia

Answer 21

General and Regional

Question 22

General Anesthesia

Answer 22

Inhaled or intravenous route (often a combination of both). Produces CNS depression. When inhaled anesthesia is used, it is often b/c it has the advantage of rapid induction, excretion and reversal of effects. Can be used for pts of any age for any surgical procedure.

Question 23

Desired actions of general anesthesia

Answer 23

• Loss of consciousness
• Analgesia
• Relaxed skeletal muscles
• Depressed reflexes

Question 24

Factors influencing which anesthesia to use

Answer 24

Type and length of surgery. Physical and psychological status of pt.

Question 25

Phases of general anesthesia

Answer 25

Induction, maintenance and emergence

Question 26

Induction Phase

Answer 26

Begins w/ administration of the anesthetic agent and continues until the pt is ready for incision.

Question 27

Maintenance Phase

Answer 27

Continues from incision until near the completion of the procedure.

Question 28

Emergence Phase

Answer 28

Begins when the pt is beginning to awake from anesthesia and usually ends when the pt is ready to leave the OR. The length of emergence depends on the depth and length of anesthesia.

Question 29

Major risks associated w/ general anesthesia

Answer 29

• Circulatory depression
• Respiratory depression
• Postoperative n/v
• Alterations in thermoregulaton

Question 30

Regional Anesthesia

Answer 30

Injected near a nerve of nerve pathway in or around the operative site. It inhibits the transmission of sensory stimuli to CNS receptors. Pt remains awake but loses sensation in specific area or region of the body. Sometimes, reflexes my be lost. Can reduce level of pain, risk of bowel obstruction and hospital stay in older adults.

Question 31

Regional anesthesia may be accomplished via

Answer 31

Major nerve blocks or spinal (subarachnoid), caudal or epidural blocks.

Question 32

Nerve Blocks

Answer 32

Accomplished by injecting a local anesthetic around the a nerve trunk supplying the area of surgery. Onset and duration depend on the drug used, concentration of drug, amount injected and the addition of epinephrine, which prolongs the block.

Question 33

Spinal Anesthesia

Answer 33

Used for surgery of abd, perineum and legs. Accomplished by injecting local anesthetic into the subarachnoid space through an LP. This causes sensory, motor and autonomic blockage. Adverse effects include hypotension, H/A and urinary retention.

Question 34

Caudal Anesthesia

Answer 34

Used for procedures of the lower extremities or perineum. Injection of local anesthesia into the epidural space into the caudal canal in the sacrum.

Question 35

Epidural Anesthesia

Answer 35

Used for surgeries of the upper and lower extremities, shoulders, thorax, abd and pelvis. Anesthetic is usually injected into the lumber space but may be used in cervical and thoracic regions.

Question 36

Topical Anesthesia

Answer 36

May be applied to mucous membranes, open skin surfaces, wounds, and burns with a drug (cocaine 4 to 10% solution, lidocaine or bupivicaine) saturated gauze or cotton-tipped applicators.

Question 37

Local Anesthesia

Answer 37

Often used in minor, short term or diagnostic procedures such as tissue biopsy. Injection of anesthetic agent (lidocaine, bupivicaine, or tetracaine to a specific area bathe the tissue area around a targeted nerve or infiltrates the underlying tissue in the operative area. Epinephrine may be used to to reduce bleeding via vasoconstriction. Local anesthesia may also be used w/ general anesthesia to prolong pain relief after general anesthesia wears off.

Question 38

Moderate Sedation

Answer 38

Conscious or procedural sedation. Used for short term and minimally invasive procedures. Pt maintains cardiorespiratory function and respond to verbal commands. IV administration of sedatives and analgesics raise the pt’s pain threshold and produces and altered mood w/ some degree of amnesia. (Twilight)