exam prep Flashcards
Surgical settings
GP practices and specialist clinics Minor surgical procedures e.g. removal of small skin cancers, biopsies.
Hospitals - general public; private; day surgery; specialist
Primary health care services - pharmacies, optometrists, dentists
Preoperative risk factors
Age Nutritional status Medical/surgical history Medications Lifestyle choices Environmental Procedural
Older adult - considerations
Metabolism Integument Respiratory Cardiovascular Gastrointestinal Liver and kidneys Cognitive Social
Pre-operative patient preparation to reduce risk
- Pre-operative preparation – MDT approach
- Assessment by nurse/surgeon/anaesthetist/allied heath e.g. pharmacist, physiotherapist etc.
- Begin discharge planning (transfer of care)– assess patient needs & wants
- Verify understanding of pre-operative orders
- Assess nutrition status,
- Provide patient education to child and family to minimise complications
Risks with obesity
Anaesthetic risk
Slower recovery from anaesthetic
Risks with obesity - Anaesthetic risk
sleep apnoea, difficulty with intubation
Risks with obesity - Slower recovery from anaesthetic
Adipose tissue stores inhalation gases, some drugs ↓mobility
May require higher dosage of medications
Nurse’s role - intra-operative
Different roles in the operating theatre e.g. anaesthetic nurse, instrument/scrub nurse, circulation/scout
Patient safety in positioning, specimen collection, surgical counts, maintaining sterile field, assist surgeon/anaesthetist or other staff as required; organize and pass equipment
Nurse’s role post-operative
Continuously assess patient ABCDE• Primary assessment - airway, breathing, circulation, disability, exposure
FGH
Secondary assessment - fluids/full set of vital signs, glucose/give comfort; head to toe assessment
Electrolytes - sodium
nerve transmission, muscle contraction, maintains normal concentration of ECF
Electrolytes - chloride
acid/base balance, nerve transmission
Electrolytes - potassium
nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF
Electrolytes - calcium
nerve transmission, muscle contraction, strong bones & teeth, blood clotting, enzyme reactions
Electrolytes - magnesium
enzyme reactions; cardiac & respiratory function
Risk of fluid & electrolyte imbalance
due to release of hormones from surgical stress e.g. ADH & aldosterone, IV fluid administration, fluid shifts, transfusion, parenteral nutrition
Risk of fluid & electrolyte imbalance - assess
Nausea, vomiting, diarrhoea, renal function, intake, output, serum electrolytes, medications (e.g. diuretics)
Risk of fluid & electrolyte imbalance - potential complications
Electrolyte imbalances Ca2+, Mg2+, Na+, K+ E.g.•
Hyponatraemia Na+<135mmol/L due to release of antidiuretic hormone which retains H2O in the circulation & dilutes Na+
Hypokalaemia K+<3.5mmol/L due to release of aldosterone which retains Na+& excretes K+
Hypovolaemia/hypervolaemia(low or excess fluid volume)
Nervous system - Potential post-operative complications
Confusion, chronic pain
Musculoskeletal system - Potential post-operative complications
Loss of mobility and strength
Endocrine System - Potential post-operative complications
Hormone imbalance such as loss of control with diabetes
Psychosocial - Potential post-operative complications
Anxiety, depression, altered body image
Respiratory system - complications - why?
Anaesthetics ↓respiratory function
Respiratory system - complications
↑ secretions & bronchoconstriction & inability to exchange gases
Atelectasis due to incomplete expansion of the alveoli
Laryngospasm – uncontrolled spasm/ constriction of the laryngeal vocal cords due to anaesthetic gas or ET tube
Nervous system - complications - why?
Anaesthetics → altered level of consciousness
