Exam 1: surgical Flashcards
Priority concepts with surgery
gas exchange, pain
Surgical care improvement project
Goal
reduce and prevent surgical complications
core measures: infections, venous thrombotic events, serious cardiac events, maintaining normothermia
ectomy
removal of an organ or gland
rrhaphy
repair
ostomy
providing an opening (stoma)
otomy
cutting into
plasty
formation or plastic repair
scopy
looking into
Ablative surgery
surgically destroy abnormal tissue or tumor
Curative surgery
resolve health problem by removing/repairing diseased tissue
Curative surgery
resolve health problem by removing/repairing diseased tissue
Diagnostic surgery
determine the origin and cause of a disorder by taking a tissue sample with the intention of diagnosing
Palliative surgery
increases the quality of life while reducing stressors on the body; non-curative
Preventative surgery
intervention with the intention that a condition will not develop
transplantation surgery
replace a malfunctioning structure
Reconstructive surgery
to improve functional ability on abnormal or damaged body structures
Timing of surgery: elective
planned, non-essential, non-acute problem
Timing of surgery: urgent
unplanned, required timely intervention, life threatening if treatment is delayed more than 24 to 48 hours
Timing of surgery: emergent
must be performed immediately to preserve life and limb
Surgical approach: simple
limited to defined anatomic location
Surgical approach: radical
involves dissection of tissue and structures beyond immediate operative site
Surgical approach: minimally invasive
fiberoptic endoscopes, smaller incisions
Surgical approach: endoscopic
diagnostic as well as therapeutic can be used in conjunction with open technique; uses natural body opening or porthole incisions
Surgical approach: open
traditional opening of body cavity, more extensive surgical approach, might produce more postop pain, longer recovery time
Pre operative: dietary restrictions NPO
patient advised nothing by mouth for 6 to 8 hours before surgery (decreases the risk for aspiration, patients should be given written and oral directions to stress adherence, surgery can be canceled if not followed)
What is the general skin preparation for pre op patients
shower using antiseptic solution–CHG wipes
How do you use an Incentive spirometer
place in sitting position
put mouthpiece in mouth and make a tight seal
take a slow deep breath, raise the blue piston and keep the blue tab between the arrows
as soon as you stop inhaling the piston will fall, continue to hold your breath for 5 seconds before breathing out. This forces the air down in your lungs
repeat this process 10 times, slowly, every hour while you are awake
When does the intraoperative phase begin
transfer of the patient onto the OR bed and continues until the patient is admitted to the PACU or ICU
What is the role of sterile drapes with microbes
surgical scrub reduced the number of resident bacteria (broad-spectrum, surgical antimicrobial solution, vigorous rubbing to create friction, scrub for another 3 to 5 minutes)
Anesthesia: induced state
partial or total loss of sensation
occurs with or without LOC
Anesthesia: purpose
block nerve transmission
suppress reflexed
promote muscle relaxation
achieve a controlled LOC
General anesthesia
reversible LOC induced by inhibiting neuronal impulses in several areas of the CNS
involves a single agent of a combo agents
4 stages of general anesthesia
Analgesia and sedation, relaxation
a. This stage can be initiated in a preoperative anesthesiology holding area, where the patient is given medication and may begin to feel its effects but has not yet become unconscious. This stage is usually described as the “induction stage”
i. Roll them into the operating room 2. Excitement, delirium
a. This stage is marked by features such as disinhibition, delirium, uncontrolled movements, loss of eyelash reflex, hypertension, and tachycardia
i. Airway reflexes remain intact during this phase and are only hypersensitive to stimulation
ii. Airway manipulation during this stage of anesthesia should be avoided
3. Operative anesthesia, surgical anesthesia
a. This is the targeted anesthetic level for procedures requiring general anesthesia. Ceased eye movements and respiratory depression are the hallmarks of this stage. Airway manipulation is safe at this level.
4. Danger/overdose
a. This stage occurs when too much anesthesia is given relative to the area of
surgical stimulation, which results in worsening of an already severe brain or medullary depression. This stage begins with respiratory cessation and ends with potential death
Local anesthesia
briefly disrupts sensory nerve impulse transmission from a specific body area or region
delivered topically and by local infiltration
Regional anesthesia
type of local anesthetic that blocks multiple peripheral nerves in a specific body region
nerve block
spinal block
epidural block
Spinal vs epidural
spinal is usually quicker response due to direct into CSF
epidural is not as good with a longer onset (25-30minutes)
When anaphylaxis occurs what is one of the signs
stridor (airway obstruction)
W/ moderate sedation: amnesia is ____ and ____ return of ADL
short; rapid
Post anesthesia care: phase 1
encompasses care of the patient from emergence until physiologically stable, including return of protective reflexes and motor function
Post anesthesia care: phase 2
begins with the return of baseline LOC, patent airway with upper airway reflexes, manageable pain, and stable pulmonary cardiac and renal funcitoning
Post anesthesia care: phase 3
23 hours observation suites in hospital units, and recovery care centers within hospital and community
What is the protocols for post op vital signs
every 15 minutes for 1 hour, every 30 minutes for 2 hours and then, every 4 hours for 24 hours
T/F the incidence of periop MI is expected to increase as the population ages and more surgical procedures are performed on older adults
T
Thermoregulation: hypothermia
shivering increases oxygen demange up to 400%
impairs coagulation
causes decreased cerebral perfusion
Thermoregulation: hyperthermia
this can be caused by an infectious process
sepsis
malignant hyperthermia (might occur or recur as late as 24 to 72 hours after surgery)
Pain management priority
expected to attain and maintain optimal level of comfort
Urinary retention is characterized by
inability to void over a 6 to 8 hours period
need foley placement
usually resolves within 48 hours
Potential complications: wound healing
factors include advanced age, nutritional status, vascular disease, diabetes
Potential complications: hemorrhage
most likely occurs within 48 hours post operatively; might be related to sutures or small vessel leakage
Potential complications: infection
factors include:
hematoma
foreign body
dead space
hypothermia
Potential complications: dehiscence and evisceration
usually occurs 3 to 10 days post op
