Chapter 17 - Preoperative Care Flashcards
PERIoperative Surgery
total surgical episode
-includes PREoperative, INTRAoperative, POSToperative periods
PREoperative
time before surgery
INTRAoperative
time during actual surgical procedure
POSToperative
period after surgery is over
reasons for surgery
- diagnosis
- cure
- palliation (alleviate sympt w/o cure)
- prevention
- cosmetic imprvmt
- exploration (determine nature/extent of disease) (less common)
-ectomy
excision or removal of
-lysis
destruction of
-orrhaphy
repair or suture of
-oscopy
looking into
-ostomy
creation of opening into
-otomy
cutting into or incision of
-plasty
repair or reconstruction of
elective surgery
carefully planned event
emergency surgery
arise w unexpected urgency
ambulatory surgery is aka
same-day or outpatient surgery
ambulatory surgery
minimally invasive techniques
6 Reasons for surgery
1 dx 2 cure 3 palliation 4 prevention 5 cosmetic 6 exploration
Fear in patients
- decrease some anxiety by giving patients info about what to expect
- reassure that drugs are avail for pain
- -teach patients to ask for med BEFORE pain becomes severe
- listen to patient’s concern w accepting attitude
antidepressants + opioids
antideps can POTENTIATE effect of opiods
Hx antihypertensive drugs predispose patients to ____
shock
-fr combined effect of drug (lowering BP) +vasodilating effects of anesthetics
insulin/oral hypoglycemic drugs needs to be adjusted bc ___
- incr body metab
- decr oral intake
- stress
- anesthesia
NSAIDs stands for
non steroidal anti inflammatory drugs
NSAID + anti platelet drugs can ___
inhibit platelet aggregation > incr postop bleeding
options for patients w long-term anti-coag therapy
1 cont therapy
2 withhold therapy for a time before + after surgery
3 withhold therapy + start subQ or IV heparin during periop
herbal products that can incr BP before + during surgery
astralagus + ginseng
herbal products that can incr bleeding
cinnamon, vit E, fish oils, 4G (ginger, garlic, ginseng, gingko)
herbal products that can cause excessive sedation
kava + valerian
allergy/anaphylactic rxn effects
- hives
- hypotension
- tachycardia
- bronchospasms
diuretic therapy will require…
serum K levels drawn before surgery
hypertensive patients may require ___
vasoactive drugs to maintain adequate BP
patient w prosthetic heart may require ____
antibiotic prophylaxis
-decr the risk for endocarditis
upper airway infection may increase risk for
- bronchospasm
- laryngospasm
- decreased O2 sat
- problems w resp secretion
Hx of COPD is at high risk for
pulm complications like HYPOXEMIA + ATELACTASIS
Smoking
- stop w/in 6 weeks before
- incr risk for for pulm complication during + after surgery
Renal dysfunction
- fluid + electrolyte imbalance
- coagulopathies
- incr risk for infections
- impaired wound healing
- altered response to drugs
- unpredictable drug elimination
testing for renal functions
BUN
serum creatinine
urinalysis?
what are normal liver functions?
- glucose homeostasis
- fat metab
- protein synth
- drug + hormone metab
- bilirubin formation + excretion
hepatic dysfunction
incr risk for clotting abnormalities
adverse response to drugs
common diabetes complications
hypo/hyperglycemia
delayed wound healing
infection
Addisonian crisis/shock
occurs if patient ABRUPTLY stops taking corticosteroid
Corticosteroid
used in immunosuppressive doses may be TAPERED before surgery
high albumin
protein makes drugs less active
-interferes w distribution
obesity
- stresses heart + resp
- makes access site more difficult
- predisposed to wound dehiscence
- high risk for wound infection
- high risk incisional herniation
- slower to recover fr anesthesia bs fat absorbs + stores inhalation agents
important substances for wound healing
protein, vit A B C
American Society of Anesthesiologists [ASA] Physical Classification System
physical status rating for anesthesia admin
P1 (ASA I)
normal healthy person
P5 (ASA V)
moribund patient - NOT expected to survive without surgery
P6 (ASA VI)
declared brain dead
-organs being removed for donor purposes
importance of teaching
- incr patient satisfaction
- reduce anxiety
- decr dvlpt of complications
- decr length of hospitalization
- decr recovery time
3 types of info in teachings
1 sensory (hear, smell, feel)
2 process info (general flow of info)
3 procedural info (detailed info)
all patients should receive instructions about _____
- deep breathing
- coughing
- ambulation
why do we restrict fluid + food intake
reduce risk for aspiration, nausea, + vomiting
why do we encourage patients to void before preop drugs?
empty bladder prevents involuntary elimination during op
-reduce risk for urinary retention during early post op
preop med + purpose
1 benzo> sedative + amnesic 2 anticholinergic> reduce secretion 3 opioid> analgesic/pain 4 antiemetics> decr n/v 5 B-adrenergic blockers> control BP, prevent MI/cardiac arrest
patients w known hypertension or coronary artery disease (CAD) may receive ___
B-adrenergic blockers
- controls BP
- reduce chance of MI or cardiac arrest
