Exam 4: Chapter 17 - Preoperative Nursing Management Flashcards
Preoperative phase begins when
the decision to proceed with surgical intervention is made and ends with the trasnfer of the patient onto the operating room bed
Intraoperative phase begins when
the patient is transferred onto the OR bed and ends with admission to the PACU
Postoperative phase begins with
the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home
Examples of surgeries to facilitate a diagnosis?
Diagnostic procedure such as a biopsy, exploratory laparotomy, or laparoscopy
Examples of surgeries for cures?
Excision of a tumor or an inflamed appendix
Examples of surgeries for repair?
Multiple wound repair
Examples of reconstructive or cosmetic surgeries?
Mammoplasty or a facelift
Examples of Palliative surgeries?
To relieve pain or corect a problem - such as debulking a tumor to achieve comfort, or removal of a dysfunctional gallblader
Examples of rehabilitative surgeries?
Total joint replacement surgery to correct crippling pain or progression of degenerative osteoarthritis
Surgeyr can also be classified upon the degree of urgency involved:
Emergent, Urgent, Required, Elective, and Optional
What is Emergent Surgery?
Patient requires immediate attention; disorder may be life threatening
Emergent Surgery Indications?
Without delay
Examples of Emergent Surgery
Severe Bleeding
Bladder Obsturction
Gunshot
What is Urgent Surgery?
Patient requires prompt attention
Urgent Surgery Indication?
Within 24-30 hours
URgent Surgery Examples
Acute gallbladder infection
Kidney or ureteral Stones
What is required surgery?
Patient needs to have surgery
Required Surgery Indications?
Plan within a few weeks or months
Required Surgery Examples?
Prostatic Hyperplasia without Bladder Obsturction
Thyroid Disorders
Cataracts
What is Elective Surgery?
Patient should have surgery
Elective Surgery Indications?
Failure to have surgery not catastrophic
Elective Surgery Examples
Repair of Scars
Simple Hernia
Vaginal Repair
What are Optical Surgery?
Decision rests with patient
Optional Surgery Indication
PErson Preference
Optional Surgery Example
Cosmetic Surgery
The nurse may ask the patient to sign the consent form and witness the signature; however it is
the surgeons responsibility to provide a clear and simple explanation of what surgery will ential prior to the patient giving consent
If a patient states that they are allergic to _____ there may be an association with an allergy to latex
kiwi, avocado, or banana, or cannot blow up balloons
What can lead to significant problems in patients with comorbid medical condition or in older adults?
Dehydration, Hypovolemia, and Electrolyte Imbalance
Why is Dentition important?
Decayed teeth or dental prostheses may become dislodged during intubation
Condition of mouth important because this can become a source of postoperative infection
Alcohol can do what to the body post-surgery?
Ingesting even moderate amount of alcohol can weaken patietns immune system and increase chance of postoperative complications
Drugs can do what to the body?
Impede the effectiveness of some medications
REspiratory Status: Patient educated about
breathing exercises and use of an incentive spirometer to achieve optimal respiratory function prior to surgery
REspiratory Status: Surgery postponed for
elective cases if the patient has a respiraotry infection.
REspiratory Status: Patients who smoke are urged to stop
30 days before surgery to significantly reduce pulmonary adn wound healing complications
REspiratory Status: Patients who smoke are likely to experience
poor wound healing, a higher incidence of SSI, and complications that include VTE and Pneumonia
CArdiovascular Status: Preparation includes
ensuring that the cardiovacular system can support the oxygen , fluid, and nutriitonal needs of the perioperative period
CArdiovascular Status: If patietn has uncontrolled hypertension,
surgery may be postpond until the blood pressure in udner control
Hepatic and Renal Function: Presurgical goal is
optimal function of the liver and urinary systems os the medications, anesthetic agents, body wastes, adn toxins are adequately metabolized and removed from the body
CArdiovascular Status: Disorders of the liver may substantially affect how
anesthetic agents are metabolized
CArdiovascular Status: Acute liver disease associated with
high surgical mortality;preoperative improve in liver function is a goal
CArdiovascular Status: Kidneys involved in excreting
anesthetic medications and their metabolites; therefore, surgery is contradicted when patient has acue nephritis, acute renal insufficiency with oliguria or anuria
Endocrine Function: Patient undergoing surgery is at risk for both
hypoglycemia and hyperglycemia
Endocrine Function: Hypoglycemia may develop during
anesthesia or postoperatively from inadequate carbohydates or excessive administration of insulin
Endocrine Function: Hyperglycemia can
increase the risk of surgical wound infection, and may result from the stress of surgery which can trigger increased levels of catecholamine
Endocrine Function: Patients with uncontrolled thyroid didsorders are at risk for
thyrotoxicosis or respiraotry failure
Immune Function: Lab tests used to test infection include
WBC and the Urinealysis
Immune Function: Immunosuppression is common with
corticosteroid therapy , organ transplation, radiation therapy, chemotherapy, and disorders affected the immune system
What should not be used 7-10 ddays before surgery?
Aspirin. It inhibits platelet aggregation and increases the risk of bleeding
What occurs during PAT?
REsources made available related to patient education such as audiovisual resources, written instructions, telephone numbers
Education should go beyond descriptions of the procedure and should include
explanations of the sensations the patient will experience.
Nursing Interventions: Providing Psychosocial Inerventions Examples
REducing Anxiety, Decreasing Fear
Respecting Cultural, Spirtual, Religious Beliefs
What should the pt do if thoracic or abdominal incision is anticipated and they want to minimize pressure and control pain?
Patient should put palms of both hands together , interlacing fingers snugly
If the ptient does not cough effectively, what can occur
Atelectasis (Collapse of the Alveoli), Pneumonia, or other lung complications may occur
Preoperative Instructions to Prevent Postoperative Complications
Diaphragmatic Breathing Coughing Leg Exercises Turning to the side Getting Out of Bed
What is Imagery?
The patient concentrates on a pleasant experience or restful scene
What is Distraction?
Patient thinks of a enjoyable story or recites a favorite poem or song
What is Optimistic Self-REcitation:
Patient recites optimistic thoughts “I know all will go well”
What is a Music Coping Strategy?
Patient listens to soothing music
Protecting patients from injury is one of the major roles of the periopertive nurse. Adherence to what is crucial?
AORN-recommended practices and the Joint Commission’s National Patient SAfety Goals
Summary of the 2016 National Patieetn Safety Goals
Identify Pts Correctly
Improve Staff Communication
Use Medicines Safely
Prevent Infection
IDENTIFY PATIENT SAFETY RISKS
Prevent mistakes in surgery
The purpose of withholding food and fluid before surgery is to prevent
aspiration
For Example Adults may be advised to fast for
8 hours after eating fatty food and 4 hours after ingesting milk products
Healthy patients are allowed clear liquids up to
2 hours before an elective procedure
Enemas are not commonly prescribed preoperatively unless the patient is undergoing
abdominal or pelvic surgery
A cleansing Enema or Laxative may be prescribed at what time?
The eveneing before surgery and may be repeated the morning of surgery
A dressing is place on what during surgery?
The Coccyx, because they want to prevent a pressure ulcere. This is taken off in the recovery room
All patients should ___ immediately before going to the OR
Void
Expected Patient Outcomes
Decrease Anxiety and Fear
Understanding Intervention
No Evidence of Preoperative Complications
