Exam 2 Flashcards
What is the definition of surgery?
The art of science of treating diseases, injuries, and deformities by operation and instrumentation
What is our job as a nurse when it comes to surgery?
-Prep pt for surgery
-Caring for pt before, during, and after surgery
What is included in the perioperative period?
-Preoperative period
-Intraoperative period
-Postoperative period
-ectomy
removal of
-lysis
destruction of
-orrhaphy
repair or suture of
-oscopy
looking into
-ostomy
creation of an opening
-otomy
cutting into
-plasty
repair or reconstruction of
What is the purpose of a diagnosis?
Used to determine the presence and extent of a condition
What is the purpose of a cure?
Eliminating or repairing the pathological condition
What is the purpose of palliation?
Alleviation of symptoms without a cure
What is the purpose of prevention?
Removal of something that may be an issue
-Ex: colonoscopy
What is the purpose of cosmetic improvement?
Altering of physical appearance
-Ex: burn scar, breast reconstruction after a mastectomy
What is the purpose of exploration?
Determines the nature or extent of disease
Why is explorative surgery least common?
Some symptoms that occur can be handled non-invasively
What are the common purposes of surgery?
-Diagnosis
-Cure
-Palliation
-Prevention
-Cosmetic improvement
-Exploration
How is surgical setting determined?
-Type of surgery
-Complications
-Pt status
-Elective or emergent
What are characteristics of elective surgery?
-Carefully planned event
-Same day admission
-Acute/chronic medical conditions
-Same day/outpatient
-Minimally invasive (laparoscopic, endoscopic)
-24-hr stay after surgery
-Home with a caregiver (at least 24 hrs as safety concern)
-Decreased cost (no extra labs, scans, foods, etc)
-Recover at home
What are different places for elective surgery?
-Ambulatory clinic
-Endoscopy clinics
-Physicians’ offices
-Outpatient surgery units in hospitals
Are HAI occurrences increased or decreased with Elective surgery?
Decreased, less time spent in center
What are the 3 types of anesthesia?
-Local
-Regional
-General
What is local anesthesia?
-Minimal
-Only numb to the specific area
Ex: wisdom teeth removal
What is regional anesthesia
Occurs around the complete area
-Ex: shoulder surgery
What is general anesthesia?
All over the body
What happens to a patient’s stress and anxiety levels when they undergo emergency surgery and why?
-Levels increase
-Pt doesn’t have time to prepare or think about the risks and benefits of surgery
What is the nurse’s role in patient care when it comes to the reason for surgery?
-Help with education for post surgery
-Plan prep for before surgery (like diet changes)
True or False:
Nurses education patient about the surgery
False- the doctor is the only one to be educating patient about surgery
What is the nurse’s role in patient care when it comes to the results of preop diagnostic tests?
Have to ensure that we notify the physician and keep pt up to date on:
-Labs
-Chest c-rays
-CT scans
What is the nurse’s role in patient care when it comes to the risks and complications of the procedure?
Want to ensure pt and family understand the plan
What is the nurse’s role in patient care when it comes to communication before surgery?
Ensure that we talk to pt about pre-surgical teaching and medications
What is the nurse’s role in patient care when it comes to documentation regarding surgery?
-Always make sure this is done
-Nurses can only witness after the doctor has talked to the pt
What do you need to obtain in a preoperative interview with the patient?
-Health info
-Drug and food allergies
-Provide and clarify info for surgery/anesthesia
-Assess client’s emotional state and readiness for surgery (expected pt outcomes)
What are examples of anticoagulants?
-Heparin
-Eloquis
-Warfarin
What question should you ask yourself when speaking to a patient before surgery?
Has the patient received enough information to make an informed decision [about the surgery]?
What are the overall goals of a preoperative interview?
-Establish baseline data (vitals) for comparison in other surgery phases
-Determine pt’s psychological and physiological status prior to surgery
-Identify and document surgical site
-Identify any and all meds that may impact outcome of surgery
-Review pre-diagnostic results (normal vs abnormal)
-Identify culture and ethnic factors to determine plan of care
-Verify pt is well informed
What are the typical reasons why patients experience anxiety before surgeries?
-Lack of knowledge
-Uncertainty of outcomes
-Past experiences or stories
-Conflict with religious or cultural beliefs
What are common fears of patients going into surgery?
-Fear of death (most common)
-Fear of pain and discomfort (2nd most common)
-Fear of altered body image
-Fear of anesthesia
-Fear of disruption of life functioning
True or False:
Hope can be a method of coping
True- it is a positive attribute
What subjective data do you need to obtain from a patient preoperatively regarding their past health history?
-Past hospitalizations
-Previous surgeries and dates
-Problems with previous surgeries
-Last menstrual period/# of pregnancies
-Family hx (especially bad outcomes)
-Current meds (including herbal products/dietary supplements)
-Allergies/drug intolerances
-Substance abuse
What is a drug intolerance?
Experiencing side effects from taking medications
-Ex: experiencing the side effect of dizziness when taking BP meds
-Ex: Experiencing muscle cramps when taking cholesterol meds
What is a true allergy?
-Swelling
-Rash
-Anaphylaxis
What objective data do you need to obtain from the patient preoperatively?
-Physical examination
-Recent H& P
-Diagnostic studies
When should a H & P be obtained preoperatively?
In advance or day of surgery
Who can collect an H&P?
-Physician
-Surgeon
-Anesthesiologist
***RNs cannot collect this
What does an H&P do preoperatively?
-Helps determine physical status rating for anesthesia
-Helps identify perioperative risks
-Can influence decision for surgery
What diagnostic studies need to be collected preoperatively?
-Coagulation profile if on antiplatelet drug
-Potassium level if on diuretic (3.5-5 range)
-Pregnancy test for all women of childbearing age
-EKG with history of dysrhythmias, hypertension
-Blood glucose test if diabetic
- +MRSA - presurgical antibiotics (help treat before there is a bigger infection)
What systems are included in a thorough head to toe assessment?
-Cardiovascular
-Respiratory
-Neurological
-Urinary
-Hepatic
-Integumentary
-Musculoskeletal
-Endocrine
-Immune
-Nutritional status
-Fluids and electrolytes
What factors affect teaching to patients?
-Physical
-Psychological
-Sociocultural
-Learner
Why are written materials used in preoperative teachings?
-Used to review/reinforce instruction at home
-Focuses on safety
What are the benefits of preoperative teaching?
-Increases pt satisfaction
-Reduces fear, anxiety, stress
-Decreases development of complications
-Decreases length of stay
-Decreases recovery time after discharge
How does preoperative teaching decrease the development of surgical complications?
Teaching is so effective that pt feels informed enough to be able to recognize abnormalities quicker and know how to continue care
What is sensory teaching?
Ensure we talk to patient about the environment of the operating room
Ex: room is cold, lights are bright, how everything looks, etc
What is process teaching?
Discuss admission/admission area
Ex: What the area looks like, when they should arrive, what items they can bring with them, where the caregiver stays
What is procedural teaching?
Explaining what types of clothes to wear, status change, fluid and food restrictions (these can interfere with anesthesia and puts pt at risk for aspirations)
What are preoperative teachings for general surgery?
-Deep breathing
-Coughing
-Early ambulation
-Contradictions or specific needs
-Monitoring devices used post-op
-PCA (Pt Controlled Analgesic)
-Rate pain
What is one of the best things to do for a patient post-operatively?
Early ambulation
What is a PCA?
-Pt Controlled Analgesic
-Pain pump that is connected to IV/IV pole
-Physician has an order of how much pain meds/at what rate the pt can receive meds
-Pt presses button to administer meds when feeling pain
True or False:
Every time the pt presses the PCA button, they receive the pain medications
False- this is preset and ordered by doctor and requires 2 checks
What are some preoperative teachings for ambulatory surgery?
-Telephone before/after to reinforce teaching
-Give directions
-Arrival time
-Specific instructions
-Restricting fluids/NPO
What is the definition of informed consent?
Active, shared decision-making process between the physician and recipient of care
Who is responsible for obtaining informed consent?
Surgeons are responsible for obtaining (they’re name goes on the signature line for provider)
**Nurses can be asked to witness and serve as pt advocate
What needs to be adequately disclosed to pt for informed consent?
-Diagnosis
-Nature and purpose of the proposed treatment
-Risks and consequences of the proposed treatment
-Probability of a successful outcome
-Availability, benefits, and risks of alternative treatments
-Prognosis if treatment is not instituted
What event do patients have to show a clear understanding of the information prior to undergoing?
Prior to receiving sedation because it impairs pt cognition & therefore they cannot make informed consent
True or False:
A true medical emergency can override the need to obtain consent
True
True or False:
The next of kin may given consent when immediate medical treatment is necessary to preserve life, or prevent serious impairment to life or limb
True
Can an emancipated minor give consent?
Yes
Who cannot give consent?
-Minors (under 18)
-Unconscious
-Mentally incompetent
Who takes precedent over next of kins?
-POA (Power of Attorney)
**If you don’t have a POA, then you would use your next of kin
What is on the day of surgery checklist?
-Preoperative teaching
-Assessment
-Communication of pertinent findings
-Ensure all preop orders are done and charted
-Informed consent
-H&P
-Labs, diagnostic tests
-Documented consultations
-Baseline VS
-Skin prep
What are preoperative medications?
-Benzodiazepines
-Anticholinergics
-Opioids
-Antidiabetics
-Antimetics
-Antibiotics
What do benzodiazepines do?
-Decrease anxiety, induce sedation
-Ex: Valium, Ativan
What do anticholinergics do?
-Reduce secretions
-Ex: Scopolamine, Atropine
***Side effect: dry mouth
What do opioids do?
-Decrease pain
-Anesthetic needs
-Ex: Fentanyl, Morphine
What do antidiabetics do?
-Stabilize blood glucose
-Ex: insulin
What do antimetics do?
-Decrease nausea
-Ex: Zofran
What do antibiotics do?
-Prevent post-op infections
-Can be given as a single dosage or within 30-60 mins of incision occurring (usually given IV)
-Given if: hx or arrhythmias, joint surgery, wound contamination possibilities
What does culture determine in culturally competent care?
-Expression of pain
-Family expectations
-Ability to verbally express needs
-Family included in all decisions (respect these decisions)
-Contact translator if needed for communication
True or False:
A family member can be used to help interpret for the patient
False- rely on hospital provided translator
What are facts of ambulatory care in an intraoperative care setting?
-Minimally invasive
-Endoscopes, robotics
-Decreased blood loss
-Decreased incision size
-Decreased pain & recovery time
-Decreased length of hospital stay
What are the rules of the semi-restricted area?
-Preparation room
-Staff in clean surgical attire dedicated to surgery use (clean, hospital provided scrubs)
-Shoe covers, surgical head cover, mask, face shield
What are the rules of the unrestricted area?
-Main registration area
-Street clothes interact with those in scrub attire
-Ex: Holding areas, locker rooms, nurse’s station
What are the rules of a restricted area?
-Surgical suite or operating room
-Sterile core
-Traffic minimized
-Filters and controlled ventilated air flow
