Chapter 5 Flashcards
Emergency-Surgical Urgency
Immediate to maintain life, limb organ-AAA
Urgent-Surgical Urgency
Needed within 24-48 hrs
example Appendix, gall bladder,
Planned
Can wait, but necessary tumor, thyroid, knee replacement
Optional
Pt. Preference
Sufex you should know
ectomy- excission or removal of lises- break down destruction of orophy- repair or suture of oscopy-look or view ostomy-creating a opening into otomy- what remains after cutting into ostomy-cutting into plasty-repair or reconstruction of. excission-removal of incission- cutting into
Purposes for surgery
Diagnostic surgery
Biopsy for cancer, they go in and take a look at it….take something out and get in diagnosed at the lab.
Cure
They are going to remove something that is troubling and then they will be cured. Like removing appendicitis then they are cured of their appendicitis.
Palliation- Does not fix the problme
Comfort or pain relief,
example- Most commonly it is with tumors…they are not going to cure them….they are going to take out one tumor that is palliative because it gives them some pain relief.
+ or create a colostomy to bypass a valve problem.
Cosmetic
rhinoplasty, face lift,breast jobs….Vanity, surgeries…not just for vanity…could be for cleft lip, burn victims or face transplants.
Preventitive
Questionable mole, removal plaque already….if you are getting a surgery sometimes they will take out the appendix…..if someone has a strong family of breast cancer they just remove the breast.
Exploration
Something going on they don’t know what it is….so they just need to go in to take a look.
Surgical Urgency- How important is it to do this today.
EMERGENCY
Immediate to maintain life, limb, organ.
example AAA- Abdominal aortic Arianism-size of a garden hose bulge.
Urgent
Needed within 24-48 hrs. example of this would be appendix-can rupture appendicitis, gall bladder.
Planned or required surgery
Can wait but it is necessary. examples depends on what type of tumor, thyroid, knee replacement.
Elective
Pt preference- most of the plastics breast are elective like lasix surgery.
Optional
Patients preference-like if you have a bump in arm and it is up to you if you want to take it out.
(There is a issue and you can fix it or not…like if you are old and have cancer it might give you another three months)
Surgery Settings
Inpatient
Same Day admission
example Knee-they have their surgery then they are admitted right afterwards.
Also they can be in the hospital for something else….theer. n they do lat
Surgery Setting Ambulatory Care (minor surgery)
Same day
Outpatient-Have surgery recover for a couple hours and go home.
ORTHOSCOPY would be done in the ambulatory care center.
Nursing Assessment
-Psychological status
What is there coping strategies
-What is there state of mind
What might affect there state- how much they know and the risk. After affects. Do they need to work, fears. Assess where they are psychologically and psycoally.
Physiologic factors
Operative Risk Factors
Baseline Data
For Comparison
Important- We need to know what the normal was for the first person. (MUST KNOW BASELINE) to compare the before and after affects.
Documention
Surgical site and side
In preoptive what we are going to document on the patient is their left site and side. What that means is right KIDNEY, LEFT ARM…THE DOCTOR has to WRITE right on the limb…The nurse has to make sure all the documentation is sent in the order says the same THING.
Medications
Prescription, OTC, herbs, ETOH, tobaccor, recreational drugs.
LOOK AT ALL BOTH PRESCRIPTION AND OVER THE COUNTER and if they have any HERBS because they interact with MEDICATIONS.
Tobacco use affects
Blood Pressure and Lungs-Some doctors won’t even operate if you did not quit for six months.
Alcohohal and drug use
If someone is addicted to opiates and they are taking Oxycodone and we try to give them pain meds it is not going to numb them up because they built up a tolerance.
NURSING ASSESSMENT we want to look at their labs and diagnostic tests.
Depending on the need for the surgery they are going to have labs done. There may be something in the chart or it may be drawn.
Most important electrolyte for surgery
Potassium because of heart arrythmias.
Cultural ethnic factors that may effect religious experience.
Jehova witness is a big one. They won’t take blood or blood products that they may or maynot take plasma protein or abumin but whole blood no….Cultural things females don’t want males near them they won’t take off their bra….or if they get in the OR everything comes off. Wear it until they go to sleep.
Consent sign
Make sure they have had adequate information from the doctor and that the consent has been signed. By both Patient and Surgean….It is the Surgeans responsiblity to answer all questions about the surgery and explain any questions that the patient may have. But the NURSE still needs to follow up and to ask them questions to make sure they are OK and KNOW what they are going to have what is going on today.
-Do you feel comfortable with that…..and if not have the doctor have them talk to them again.
Allergies
We are going to assess for allergies both food and nondrugs.
If SOMEONE DOES NOT know they have a LATEX allergy what do we ask them what they are allergic too?
PITTED FRUITS, STONE FRUITS-PEACHES, AVOCADO, NECTORIN, BANANA
Allergic to SHELLFISH
IODINE
CLICKER
What type of surgery is a total KNEE REPLACEMENT
ANSWER PLANED
PSYCHOLOGICAL ASPECTS
How much time have they had to adjust to this procedure
-Have they had time to adjust and plan or is it sudden.
Common Fears
Unknown, How much pain are they going to be in afterwards.
- Death and disfigurement. Anesthesia.
- PROFORAL
- Financial ramifications- if they can’t work or if they don’t have insurance.
Pain SCALE 0
IS UNREASNABLE- YOU HAVE TO POINT OUT THAT THEY JUST HAD MAJOR SERGERY
Hope may be the patients strongest mechanism for HOPING
YOU WANT TO FOSTER THAT HOPE, DON’T MAKE ANY PROMISES-TELL THEM WE ARE GOING TO TAKE REALLY GOOD CARE OF YOU….
To help PROMOTE PYCHOLGICAL READYNESS we do a lot of active listening.
ASK A LOT OF OPEN ENDED QUESTIONS. Ask FOLLOW UP QUESTIONS AS THEY ARE TELLING YOU.
PREOP TEACHING
KEEP IT IN THE SHORT TERM- TEACH THEM what they need to KNOW IMMEDIATLY, what they are going to experience in the OR and a little afterwards.
TELL THEM WHAT THEY ARE GOING TO SEE AND WHY?
ALWAYS EDUCATE on the IS
INCENTIVE SPIRAMATOR after each SURGERY
You want to talk to the patient about
PAIN CONTROL- EXPLAIN we will do our very best to keep you out of pain and tell them what you know about what is happening.
Pre OP teaching
Give them a run down on what they are going to feel. example so you are going to get a tube placed down your mouth when it is removed you are going to have a little bit of a sore throat. (QUICK RUN DOWN) on what ever it is going to be.
Family TEACHING
Tell them where they can wait and that the doctor will come out to them and explain to them after he is done. (Surgery 90 minutes then they will be out on the PACU for two hours then you can see them around three oclock….This is how it normally goes but the doctor will come out and give you a heads up.
QUADS ISOMETRIC EXERCISES
HELPS TO RETURN BLOOD TO HEART and GLUTEAL SETS ARE THE SAME THINGS.
Teach them to do ANKLE PUMPS…
SAY THINGS THEY UNDERSTAND AND CAN RELATE TOO.
Why do you have to chart pain immediately after PAIN MEDICATION IS GIVEN.
To see if it was successful….we have to quantify it.
Promoting Psych Readiness- Pre-Op about to go it
Orient them only about their immediate future.
FOCUS ON THE IMMEDIATE FUTURE ONLY- They are freaking out.
-Make sure they know what they are having done to them. (then you may want to refer them back to the surgeon to get some more information)
-Get a brief history-ASK THEM THE SAME QUESTION. -SECOND TIME WE ASKED THEM>….DOUBLE AND TRIPLE CHECKS FOR THEIR SAFETY.
+ TELL THEM WHAT IS GOING TO HAPPEN IN THE NEXT FEW MINUTES dealing with the surgery. TELL THEM WHAT THEY CAN EXPECT IN THE OR.
-+TELL ALL THE STUFF TO THE PATIENT….EDUCATE ABOUT IS EVERY DAY FOR THE REST OF YOUR LIFE.
PRE OP TEACHING
expalin
- OR IS COLD
- LOTS OF BRIGHT LIGHTS
- ASPECTIC SMELL
- LOTS OF NOISE
PRE OP TEACHING PROCESS
- TRANSFER TO THE HOLDING AREA
- VISIT BY NURSE, ANESTHESIA CARE PROVIDER
- VISIT BY SURGEON-HE WILL MARK THE SITE AND SIDE
- ASKED to move on narrow bed with strap over thighs.
- Walking up in the PACU (Family can come visit now.
Cardiovascular system
- Vitals recorded pre opertively for baseline-HEAD TO TOE BEFORE THEY GO IN.
- Bleeding/clotting times
- Laboratory reports
- Possible prophylactic antibiotics
- Your patient has Hx of Cardiac disease what might you see ordered for thi9s patient (to assess for cardiac rhythm. Do all patients have this order. .
We will do a head to toe…
-We want to know if they have any HEART ISSUES or if they HAVE A PASTE MAKER.
-ARTIFICIAL VALVE or do they have any stents.
-ANY HEART ATTACKS….IF THEY ANSWER YES THEN WE WILL NEED AN EKG PRE GOING IN.
SHOULD ALREADY BE IN THE CHART AND IF NOT FIND OUT WHY. EVERYONE DOES NOT GET AN EKG ONLY IF THEIR IS A RISK.
ALSO, want to know if there was any blood thinners or BP MEDS and if SO
WHEN WAS THE LAST TIME THEY TOOK THEM.
-IF ELECTIVE SURGERY THEY WANT THEM OFF THE THINNER FOR 5 DAYS.
BP MEDS - THEY WILL HAVE THEM TAKE THEM THAT DAY.
WE DON’T WANT THEM TO EVEN TAKE BABY ASPIRIN PRIOR TO THE SURGERY.
RESPIRATORY SYSTEM WE TO KNOW
IF THEY HAD ANY COUGH-
IMOSTICES, any cough or anything thing comming up with that cough….do you have COPD or ASTHMA or do they SMOKE.
+PROCEDURE could be cancelled because of increasse risk of larygo/bronospacm or decrease SaO2.
+Chronic illness.
HOW LONG HAVE THEY SMOKED….GREATER PACK YEARS…..GREAT RISK….CAN’T SMOKE FOR SIX WEEKS.
(CONSTRICTS BLOOD VESSELS, LONGER TO HEAL.
IF YOU HAVE A PRODUCTIVE COUGH with GREEN SPUTUM who should you notify?
THE SURGEON.
WHAT MIGHT THEY ORDER: SPUTUM CULTURE or MAY WANT TO ORDER A CHEST X RAY JUST TO SEE HOW THE SPUTUM GOES.
Nervous system you want to check
CHECK VISION or HEARING or understaind so if their is any deficits we can correct it….If they are having trouble with glasses get them or if they need a hear aid we need to get it. BEFORE GIVING THEM THE INFORMATION-IMPORTANT to commuicate with these patients.
Assess for any cognitive IMPARIMENTS
If patient is not congnitive make sure we have their care givers or power of attorney with them. Make sure we have it documented POWER of ATTORNEY.
Make sure they can concentrate or RESPOND
We need to tell them what we are doing before we do it. Or do it as we are doing it before they go to sleep.
Who can sign for a PATIENT
POWER OF AN ATTORNEY.
RENAL SYSTEM THEY MAY DO RENAL FUNCTION TEST
+CREATINE to make sure the kidneys are functioning so they can process the medications they will be getting.
Urinary system we want to ask?
If they had any trouble voiding. Let the TEAM KNOW if they do….We want to know if they have a UTI or a history of glomular nephritis. Problems if they have a strep infections.
We want to do a PREGNANCY TEST
Of anyone who is of child bearing age. Because Anestitia can harm the FETUS. So unless they can say absolutly prove they are not pregnant they SHOULD HAVE A TEST.
We are going to look at their FLUID and ELECTROLYTE BALANCES.
So we will CHECK SOIDIUM and POTASIUM……FOR HEART….MAJOR DYTHRIMTHMIAS.
BIG THING WITH THE KIDNEYS IS WE WANT TO MAKE SURE THEY CAN -METABOLIZE THE DRUGS we are giving them.
OK
Skin Integmentary SYSTEM
We are just looking at it to make sure we do not have any breakdown, we will not the color.
Remember that during surgery we are going to be in one situation for a long time so we want to look at the skin before hand to make sure that when we look at it afterwards their is no difference.
-Want to make sure everything is well padded. So there should be NO CHANGE IN THE SKIN….MAKE SURE WE GIVE A GOOD THROUGH SKIN ASSESSMENT because HOSPITALS don’t get PAID NOW if a PROBLEM HAPPENS WITH THE SKIN.
