CONCEPT OF SURGERY Flashcards
The art of healing by manual operation;
Done for the healing of diseases or injuries of the body;
Its objective is to cure local injuries or diseases, such as wounds or fractures, tumors, etc.
SURGERY
Deviation from normal structure or location in any organ or part of the body that is present from birth
CONGENITAL ANOMALIES
What is VACTERL
V-ertebral defect
A-nal malformation
C-ardiac Anomaly
T-racheoesophageal fistula
E-sophageal atresia
R-enal Anomaly
L-imb defect
What is POET
Perforation, Obstruction, Erosion, Tumor
rupture of an organ
PERFORATION
impairment to the flow of vital fluids
OBSTRUCTION
Wearing off a surface or membrane
EROSION
abnormal new growth
TUMOR
CLASSIFICATIONS OF SURGERY
ACCORDING TO PURPOSE
ACCORDING TO URGENCY
ACCORDING TO RISK
confirm the disease
DIAGNOSTIC
repairs congenital defect (cheiloplasty)
CONSTRUCTIVE
repairs damaged organ (skin grafting)
RECONSTRUCTIVE
to relieve pain or correct problem (Gastrostomy, colostomy, ileostomy)
PALLIATIVE
deformity (arthroplasty)
RESTORATIVE
(without delay); severe bleeding, fractured skull, gunshot wound
EMERGENCY
(within 24-30 hours); gall bladder infection
URGENT
(within few weeks or month): cataract
REQUIRED
Failure of surgery is not a catastrophe (e.g., repair of scar, vaginal repair)
ELECTIVE
(personal preference): cosmetic surgery
OPTIONAL
(Ambulatory Surgery): done on Outpatient basis
DAY
Usually involves the use of general anesthesia.
Major surgery often involves opening one of the major body cavities
The surgery is usually performed in an operating room by a team of doctors.
A stay of at least one night in the hospital is usually needed after major surgery.
MAJOR SURGERY (HIGH RISK)
Can involve the use of local, regional, or general anesthesia.
Major body cavities are not opened.
Minor surgery may be performed in an emergency department, an ambulatory surgical center, or a doctor’s office.
MINOR SURGERY (LOW RISK)
3 PHASES
Preoperative
Intraoperative
Postoperative
Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient into the operating room table
PREOPERATIVE PHASE
PREOPERATIVE NURSING ACTIVITIES
Establishing a baseline evaluation of the patient before the day of surgery by carrying out a preoperative interview
Ensuring that necessary tests have been or will be performed (pre admission testing)
Arranging appropriate consultative services
Providing preparatory education about recovery from anesthesia and postoperative care.
On the day of surgery, patient teaching is reviewed, the patient’s identity and the surgical site are verified, informed consent is confirmed and an intravenous infusion is started
Fears of the unknown
General Fears
Fear of destruction of body image
Threat of sexuality
Fear of permanent disability
Fear of dying
Fear of pain
Specific Fears
LEGAL PREPARATION-INFORMED CONSENT
To ensure that the client understand the nature and treatment including the potential complications and disfigurement
To indicate that the client decision was made without pressure
To protect the client against unauthorized procedure
To protect the surgeon and hospital against legal action by a client who claims that an unauthorized procedure was performed
Complete understanding of the procedure, its risk, benefit, complications and alternative as explained by the physician.
It is necessary in all procedures EXCEPT IN EMERGENCY
Adult >18 y/o can sign own consent, unless unconscious or mentally incompetent
Minors (<18 y/o) must have parental guardians consent unless emancipated (married, military service, etc.)
For emergencies, telephone/fax consent will do.
PHYSIOLOGICAL PREPARATION: AGE
Very young tolerate the trauma of surgery well and recover faster
Elderly tolerate surgery very poorly and chances of complications are more likely
cause potential complications postoperatively
DEHYDRATION AND MALNUTRITION
fatty tissues are not resistant to infection: dehiscence and wound infections are common.
OBESITY
ECG and blood studies are ordered routinely for adults
CVP measurement is ordered if the pt is elderly and fluid overload is a potential prob
Blood typing and cross-matching so that blood can be made available should transfusion becomes necessary postoperatively
CARDIOVASCULAR DISEASES
Chest x-ray is done routinely
PFT and ABG if interference with pulmonary function is suspected
RESPIRATORY DISEASES
Urinalysis and kidney function test are routinely done
Presence of diarrhea and constipation should be corrected before surgery
ELIMINATION DISTURBANCES
DIABETES MELLITUS: hypoglycemia may develop during anesthesia or postoperatively
ENDOCRINE DISTURBANCE
DRUGS THAT INTERFERE WITH ANESTHESIA OR CONTRIBUTE TO POST-OP COMPLICATIONS
ANTIBIOTICS, ANTICOAGULANTS, ANTIHYPERTENSIVE, DIURETICS, STEROIDS, TRANQUILIZERS, ANTIDEPRESSANTS
Neomycin, streptomycin, kanamycin when combined with muscle relaxants interrupt nerve transmission, and causes apnea and respiratory paralysis may occur
ANTIBIOTICS
Increase bleeding, aspirin potentiates action of anticoagulants
ANTICOAGULANTS
Affect anesthesia and compensatory ability of cardiovascular system
ANTIHYPERTENSIVE
Such as thiazide causes potassium loss, also cause respiratory depression
DIURETICS
E.g., dexamethasone, cause anti-inflammatory effect and delay wound healing
STEROIDS
Potentiates effect of narcotics and barbiturates, can also cause hypotension
TRANQUILIZERS
Prozac, Elavil, MAO inhibitors increase hypotensive effects of anesthesia
ANTIDEPRESSANTS
Examples of Post-Op exercises
Deep breathing exercise, coughing, splinting incision, frequent turning and leg exercises
PHYSICAL PREPARATION: GASTROINTESTINAL
NPO post-midnight
Cleansing enemas
For lower bowel surgery: magnesium citrate, neomycin, Dulcolax
H2 Blockers: Cimetidine, Ranitidine
PHYSICAL PREPARATION: URINARY
Empty the bladder
Ask the pt to go to the bathroom before pre-medications are given
PHYSICAL PREPARATION: CIRCULATORY
Antiembolic stocking for elderly to prevent venous stasis, that helps prevent thromboembolism and shock postoperatively