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MEDICAL-SURGICAL NURSING - LECTURE > CONCEPT OF SURGERY > Flashcards

CONCEPT OF SURGERY Flashcards

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1
Q

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.

A

SURGERY

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2
Q

Deviation from normal structure or location in any organ or part of the body that is present from birth

A

CONGENITAL ANOMALIES

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3
Q

What is VACTERL

A

V-ertebral defect
A-nal malformation
C-ardiac Anomaly
T-racheoesophageal fistula
E-sophageal atresia
R-enal Anomaly
L-imb defect

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4
Q

What is POET

A

Perforation, Obstruction, Erosion, Tumor

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5
Q

rupture of an organ

A

PERFORATION

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6
Q

impairment to the flow of vital fluids

A

OBSTRUCTION

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7
Q

Wearing off a surface or membrane

A

EROSION

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8
Q

abnormal new growth

A

TUMOR

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9
Q

CLASSIFICATIONS OF SURGERY

A

ACCORDING TO PURPOSE
ACCORDING TO URGENCY
ACCORDING TO RISK

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10
Q

confirm the disease

A

DIAGNOSTIC

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11
Q

repairs congenital defect (cheiloplasty)

A

CONSTRUCTIVE

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12
Q

repairs damaged organ (skin grafting)

A

RECONSTRUCTIVE

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13
Q

to relieve pain or correct problem (Gastrostomy, colostomy, ileostomy)

A

PALLIATIVE

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14
Q

deformity (arthroplasty)

A

RESTORATIVE

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15
Q

(without delay); severe bleeding, fractured skull, gunshot wound

A

EMERGENCY

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16
Q

(within 24-30 hours); gall bladder infection

A

URGENT

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17
Q

(within few weeks or month): cataract

A

REQUIRED

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18
Q

Failure of surgery is not a catastrophe (e.g., repair of scar, vaginal repair)

A

ELECTIVE

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19
Q

(personal preference): cosmetic surgery

A

OPTIONAL

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20
Q

(Ambulatory Surgery): done on Outpatient basis

A

DAY

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21
Q

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.

A

MAJOR SURGERY (HIGH RISK)

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22
Q

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.

A

MINOR SURGERY (LOW RISK)

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23
Q

3 PHASES

A

Preoperative
Intraoperative
Postoperative

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24
Q

Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient into the operating room table

A

PREOPERATIVE PHASE

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25
Q

PREOPERATIVE NURSING ACTIVITIES

A

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

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26
Q

Fears of the unknown

A

General Fears

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27
Q

Fear of destruction of body image
Threat of sexuality
Fear of permanent disability
Fear of dying
Fear of pain

A

Specific Fears

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28
Q

LEGAL PREPARATION-INFORMED CONSENT

A

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.

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29
Q

PHYSIOLOGICAL PREPARATION: AGE

A

Very young tolerate the trauma of surgery well and recover faster

Elderly tolerate surgery very poorly and chances of complications are more likely

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30
Q

cause potential complications postoperatively

A

DEHYDRATION AND MALNUTRITION

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31
Q

fatty tissues are not resistant to infection: dehiscence and wound infections are common.

A

OBESITY

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32
Q

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

A

CARDIOVASCULAR DISEASES

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33
Q

Chest x-ray is done routinely

PFT and ABG if interference with pulmonary function is suspected

A

RESPIRATORY DISEASES

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34
Q

Urinalysis and kidney function test are routinely done

Presence of diarrhea and constipation should be corrected before surgery

A

ELIMINATION DISTURBANCES

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35
Q

DIABETES MELLITUS: hypoglycemia may develop during anesthesia or postoperatively

A

ENDOCRINE DISTURBANCE

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36
Q

DRUGS THAT INTERFERE WITH ANESTHESIA OR CONTRIBUTE TO POST-OP COMPLICATIONS

A

ANTIBIOTICS, ANTICOAGULANTS, ANTIHYPERTENSIVE, DIURETICS, STEROIDS, TRANQUILIZERS, ANTIDEPRESSANTS

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37
Q

Neomycin, streptomycin, kanamycin when combined with muscle relaxants interrupt nerve transmission, and causes apnea and respiratory paralysis may occur

A

ANTIBIOTICS

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38
Q

Increase bleeding, aspirin potentiates action of anticoagulants

A

ANTICOAGULANTS

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39
Q

Affect anesthesia and compensatory ability of cardiovascular system

A

ANTIHYPERTENSIVE

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40
Q

Such as thiazide causes potassium loss, also cause respiratory depression

A

DIURETICS

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41
Q

E.g., dexamethasone, cause anti-inflammatory effect and delay wound healing

A

STEROIDS

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42
Q

Potentiates effect of narcotics and barbiturates, can also cause hypotension

A

TRANQUILIZERS

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43
Q

Prozac, Elavil, MAO inhibitors increase hypotensive effects of anesthesia

A

ANTIDEPRESSANTS

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44
Q

Examples of Post-Op exercises

A

Deep breathing exercise, coughing, splinting incision, frequent turning and leg exercises

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45
Q

PHYSICAL PREPARATION: GASTROINTESTINAL

A

NPO post-midnight
Cleansing enemas

For lower bowel surgery: magnesium citrate, neomycin, Dulcolax

H2 Blockers: Cimetidine, Ranitidine

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46
Q

PHYSICAL PREPARATION: URINARY

A

Empty the bladder
Ask the pt to go to the bathroom before pre-medications are given

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47
Q

PHYSICAL PREPARATION: CIRCULATORY

A

Antiembolic stocking for elderly to prevent venous stasis, that helps prevent thromboembolism and shock postoperatively

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48
Q

PHYSICAL PREPARATION: INTEGUMENTARY

A

Skin cleansing by means of povidone iodine and hexachlorophene
Shaving hair
Remove hairpins, wigs, nail polish

49
Q

PHYSICAL PREPARATION: NERVOUS SYSTEM

A

Barbiturates: commonly phenobarbital and secobarbital

Narcotics: meperidine hydrochloride

Anticholinergic drugs: atropine sulfate

Tranquilize: Phenergan, Diazepam:

50
Q

for sedative-hypnotic effect

A

Barbiturates: commonly phenobarbital and secobarbital and Narcotics: meperidine hydrochloride

51
Q

Reduce secretion, and block vagal stimulation to prevent bradycardia and hypotension

A

Anticholinergic drugs: atropine sulfate

52
Q

To allay apprehension and for antiemetic effects

A

Tranquilize: Phenergan, Diazepam

53
Q

OTHER PREPARATION FOR PRE-OP

A

Removal of Dentures, jewelries, pins

Identification Band

54
Q

Begins at the moment of the patient is anesthetized up to the time the last dressing on the incision is placed

The surgical teams take over the responsibility of meeting the patient needs

A

INTRAOPERATIVE PHASE

55
Q

INTRAOPERATIVE NURSING ACTIVITIES

A

Providing for the patient’s safety

Maintaining an aseptic environment

Ensuring proper function of equipment

Providing the surgeon with specific instruments and supplies for the surgical field

Completing appropriate documentation

Providing emotional support by holding the patient’s hand during general anesthesia induction

Assisting in positioning the patient on the operating room table using basic principles of body alignment

Acting as scrub nurse, circulating nurse, or registered nurse first assistant

56
Q

THE SURGICAL TEAM

A

SURGEON
ANESTHESIOLOGIST
SCRUB NURSE
CIRCULATING NURSE

57
Q

Takes responsibility for preventing serious complications
He handles organ and tissue, prevents too much blood loss by tying the blood vessel

A

SURGEON

58
Q

Visits the patient prior to surgery to acquaint him with what to expect from the anesthetic.

During operation he induces anesthesia

He pays particular attention to maintaining a clear or patent airway, adequate breathing and exchange of gases in the lungs, and systemic circulation

A

ANESTHESIOLOGIST

59
Q

Her main responsibility is to anticipate and meet the needs of the surgeon for instruments and supplies during the procedure

Prepares the equipment

Opens the major pack

Prepare the gauze, gloves, mayo table

Serving surgeon-gowning and gloving

Initial counting of the instrument together with the circulating nurse

A

SCRUB NURSE

60
Q

5 LAYERS

A

Inner to outer
Peritoneum
Muscle
Fascia
Subcutaneous- Final Count
Skin

61
Q

Is responsible for the general management of the operating room

She must anticipate and plan to meet the needs of each member of the operating team

She must be alerts to threat to the patient’s safety

She watches for the breaks in aseptic techniques

She saves and counts discarded sponges and instruments

She reminds the team that the patient is awake

She controls the number and behavior of visitors in the operating room

Assists in positioning the patient
Preparing skin for surgery

Managing surgical specimen
Documenting Intraoperative events

A

CIRCULATING NURSE

62
Q

MAIN RESPONSIBILITIES OF A CIRCULATING NURSE

A

Verifying the consent

Coordinating the team

Ensuring the cleanliness, proper temperature, humidity and lighting

Ensuring the safe functions of the equipment, and the availability of the supplies and materials

63
Q

street clothes are allowed

A

UNRESTRICTED ZONE

64
Q

consist of scrub clothes and caps

A

SEMI-RESTRICTED ZONE

65
Q

scrub clothes, shoe cover, masks are allowed

A

RESTRICTED ZONE

66
Q

Is a state of narcosis, analgesia, relaxation and loss of reflexes

A

ANESTHESIA

67
Q

the substance, such as chemical or gas used to induced anesthesia

A

Anesthetic

68
Q

TYPES OF ANESTHESIA

A

General, Balanced, Local or Regional Block, Spinal or Epidural

69
Q

Pain is controlled by general insensibility

Basic elements includes analgesia, interference with undesirable reflexes, and muscle relaxation

A

GENERAL ANESTHESIA

70
Q

The properties of general (hypnosis, analgesia, muscle relaxation) are produced in varying degrees, by combination of agent

A

BALANCED ANESTHESIA

71
Q

Pain is controlled without loss of consciousness

The sensory nerves in one area or region are anesthetized

Sometimes called conduction anesthesia

Acupuncture is sometimes used

A

LOCAL OR REGIONAL BLOCK ANESTHESIA

72
Q

Sensation of pain is blocked at a level below the diaphragm
without a loss of consciousness

The agent is injected in the spinal canal

A

SPINAL OR EPIDURAL ANESTHESIA

73
Q

What are the 4 Stages of Anesthesia

A

STAGE I - BEGINNING ANESTHESIA
STAGE II – EXCITEMENT
STAGE III - SURGICAL ANESTHESIA
STAGE IV - STAGE OF DANGER/MEDULLARY DEPRESSION

74
Q

The stage of induction extends from the beginning of the administration of the anesthetic to the beginning of loss of consciousness

The pt is aware that he is unstable to move his extremities voluntarily.

During this stage even low voices or minor sounds appear loud or distressing.

For this reason, unnecessary noise must be prevented

A

STAGE I - BEGINNING ANESTHESIA

75
Q

Extends from the loss of consciousness to the loss of eyelid reflex.

Characterized by struggling, shouting, talking, singing, laughing or even crying

The pupils of eyes are dilated but when exposed to light will contract

The pulse rate is rapid and respiration irregular

Help need to restraint the patient, strap maybe placed across the thighs

A

STAGE II – EXCITEMENT

76
Q

Reached when too much anesthesia has been given and when the patient has not been observed carefully

Cyanosis develops gradually and unless prompt action is taken, death follows rapidly.

If this stage develops, anesthesia is discontinued and artificial respiration is given.

Stimulants may be administered

A

STAGE IV - STAGE OF DANGER/MEDULLARY DEPRESSION

76
Q

Extends from the loss of lid reflex to cessation of respiratory effort

The patient is unconscious, his muscles are relaxed and most of the reflexes are absent, the pupils are small, but they constrict when they exposed to light

Respiration is regular, pulse rate is of good volume, and skin is pink and slightly flushed.

By proper administration of anesthetic, this stage may be maintained for hours

A

STAGE III - SURGICAL ANESTHESIA

77
Q

METHODS OF ANESTHESIA ADMINISTRATION

A

INHALATION, INTRAVENOUS, REGIONAL ANESTHESIA, EPIDURAL ANESTHESIA, SPINAL ANESTHESIA

78
Q

Barbiturates, benzodiazepine (Midazolam), opioid agent, diazepam (Valium), meperidine HCL (Demerol), promethazine (Phenergan)

A

INTRAVENOUS

78
Q

Administered by mixing vapors with oxygen or nitrous oxide and then having the patient inhale the mixture

The vapors are administered via tube or mask, or laryngeal mask.

Example: Volatile Liquid: Halothane (Fluothane), Methoxyflurane (Penthrane),

Gases: Nitrous oxide

A

INHALATION

79
Q

Another term for Nitrous oxide

A

Laughing Gas

80
Q

Injected around nerves so that area supplied these nerves are anesthetized

A

REGIONAL ANESTHESIA

81
Q

Locks sensory, motor and autonomic functions
ADVANTAGE: absence of headache results from subarachnoid injection

A

EPIDURAL ANESTHESIA

82
Q

anesthesia in the arm

A

BRACHIAL PLEXUS BLOCK

83
Q

A type of extensive conduction nerve block that produced when local anesthetic is introduced into the subarachnoid space at the lumbar level, usually L4 and L5

It produces anesthesia on the lower extremities, perineum and lower abdomen

Common agents used are procaine, tetracaine (Pontocaine), lidocaine (xylocaine) and bupivacaine(Marcaine)

A

SPINAL ANESTHESIA

83
Q

anesthesia on the chest, abdominal wall and extremities

A

PARAVERTEBRAL ANESTHESIA

84
Q

POSITION OF PATIENT FOR SURGERY

A

The patient should be comfortable
The operative area must be adequately exposed

Circulation must not be obstructed by any body part

There should be no interference with the patient respiration

Nerves should be protected from undue pressure.

Shoulder braces must be well padded to prevent injury

Provide patient privacy by proper draping

84
Q

produces anesthesia of the perineum and occasionally lower abdomen

A

TRANSACRAL (CAUDAL) BLOCK

85
Q

MOST COMMONLY USED OPERATIVE POSITIONS

A

DORSAL RECUMBENT OR SUPINE
PRONE
TRENDELENBURG
LITHOTOMY
LATERAL POSITIONS

86
Q

Used for hernia repair, exploratory laparotomy, cholecystectomy, gastric and bowel resection, mastectomy

A

DORSAL RECUMBENT OR SUPINE

87
Q

The arm should be well protected and carefully positioned to prevent ulnar or radial damage

A

PRONE

88
Q

For operation of the lower abdomen and pelvis to obtain good exposure by displacement of the intestine in the upper abdomen

A

TRENDELENBURG

89
Q

Used to obtain better visualization of the biliary tract

A

REVERSE TRENDELENBURG

90
Q

SKIN PREPARATION ON OPERATING TABLE: AREA

A

Done after the patient has been anesthetized and positioned on the table, skin of the operative site and extensive area surrounding it.

91
Q

This position is used for perineal, rectal and vaginal surgery

A

LITHOTOMY

92
Q

This position is used for kidney operation

A

LATERAL POSITIONS

93
Q

SKIN PREPARATION ON OPERATING TABLE: RESPONSIBILITIES

A

The first assistant is the person who scrubbed the patient after he has scrubbed his own hands and arms.

94
Q

BASIC PREPARATION FOR CLEAN AREAS

A

Don sterile gloves

Scrub skin, starting the site of incision, with a circular motion or over widening circles of periphery. Use enough pressure and friction to remove dirt and microorganism from skin and pores

Discard sponge after reaching the periphery

Repeat scrub with a separate sponge for round and apply antiseptic

Paint area with solution from incision site to periphery with circular motion

95
Q

CONTAMINATED AREAS WITHIN THE OPERATIVE FIELD

A

Umbilicus, stoma, draining sinuses, skin ulcers, vagina, anus

Follow general rule of scrubbing the most contaminated area is last with separate sponge

96
Q

ABDOMINAL INCISION 1-10

A

Kocher
Thoracoabdominal
Midline
Muscle splitting loin
Pfannenstiel
Gable
Transverse muscle splitting
Lanz
Paramedian
McEvedy

97
Q

Examples of use includes access of the biliary tract or pancreas in RUQ and access to the LLQ for resection of the sigmoid colon

A

PARAMEDIAN INCISION

98
Q

It begins in the epigastrium at the level of the xiphoid process and may vertically to the suprapubic region.

It offers excellent exposure of and rapid entry into upper abdominal content

A

LONGITUDINAL MIDLINE INCISION

99
Q

It begins in the epigastrium and extends laterally and obliquely just below the lower costal margin

Examples of use includes biliary procedures and splenectomy

A

SUBCOSTAL UPPER QUADRANT OBLIQUE (KOCHER)

99
Q

Made for increased visibility during liver transplant and resection

A

BILATERAL MODIFIED SUBCOSTAL INCISION (CHEVRON INCISION) OR GABLE

100
Q

Located at the right lower quadrant just below the umbilicus

This is a fast easy incision, but exposure is limited

A

MCBURNEY INCISION

101
Q

The patient is placed in in a lateral position, either right or left incision begins at the midway between the xiphoid process and the umbilicus extends across the abdomen to the 7th and 8th costal interspaces into the thorax

Examples of use include esophageal varices

A

THORACOABDOMINAL INCISION

102
Q

Examples of use include choledochojejunostomy and transverse colostomy

A

MID ABDOMINAL TRANSVERSE INCISION

102
Q

It provides access to the inguinal canal and cord structures

Primary use inguinal herniorrhaphy

A

INGUINAL INCISION (LOWER OBLIQUE/ MCEVEDY)

103
Q

NURSING PROCESS APPLICATION
(INTRAOPERATIVE): ASSESSMENT

A

Assess the anxiety level
Establish rapport

Check chart for the result of laboratory test

104
Q

NURSING PROCESS APPLICATION
(INTRAOPERATIVE): INTERVENTIONS

A

Relief from anxiety
Perform correct procedure to the right patient
Maintain Fluid Balance
Prevent retention of foreign body
Prevent loss of body heat
Prevent infection
Prevent injury
Respect patient ‘s privacy

105
Q

Relief from anxiety

A

Greet patient

Offer comfort measures: raising the head, offering warm blanket

Remain with the patient at all times

Maintain quiet environment to allow preoperative medication to take effect

106
Q

Perform correct procedure to the right patient

A

Name band and OR permit must be checked, the procedure and the surgeon’s name must be verified

107
Q

Maintain Fluid Balance

A

Check the chart, the hct and Hgb, amount of blood, maintain accurate input and output, assess blood loss on sponges, and in suction

108
Q

Prevent loss of body heat

A

Give warm blanket

Monitor the OR temperature and patient’s temperature

108
Q

Prevent retention of foreign body

A

The circulating nurse counts, with the assistance of another person, all instruments, sponges, pad and needles before the procedure begin and as the surgeon closes the skin

109
Q

Prevent injury

A

Position carefully and maintain body alignment

109
Q

Prevent infection

A

Monitor breaks in sterile technique and provide corrective action

110
Q

Begins from the moment surgeon completes the last stitch and continues until the metabolic and tissues changes resulting from the surgical procedure have returned to normal

A

POST-OPERATIVE PHASE

110
Q

Respect patient ‘s privacy

A

There should be no unnecessary exposure of the patient, the chart should be only available to authorized personnel, and confidentiality of all information must be maintained

MEDICAL-SURGICAL NURSING - LECTURE (1 decks)

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