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2226 > Intro To Surgical Nursing > Flashcards

Intro To Surgical Nursing Flashcards

1
Q

List the 3 phases of surgery

A

Preop
Intraop
Post op

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2
Q

Excision or removal of

A

Ectomy

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3
Q

Destruction of

A

Lysis

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4
Q

Repair or suture of

A

Orrhaphy

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5
Q

Looking into

A

Oscopy

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6
Q

Creation of an opening

A

Ostomy

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7
Q

Cutting into

A

Otomy

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8
Q

Repair or reconstruction of

A

Pasty

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9
Q

What is the pre operative phase

A

Time period between the decision to have surgery and beginning of procedure

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10
Q

Primary purpose of the Patient interview

A

Obtain health info
Clarify info about procedure
Assess patients readiness
Implement support and education

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11
Q

How can the RN be instrumental in acknowledging a patients fears and concerns regarding surgery

A

Support and education reduces fear
Restores self esteem

  • appropriate language
  • avoid jargon
  • use common language
  • provide education
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12
Q

3 categories to divide preoperative education into

A

Sensory info
Procedural info
Process info

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13
Q

Explain current fasting guidelines

A

Light breakfast up to 6 hours prior to surgery and a max of 200ml clear fluids up to 2 hours prior to surgery

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14
Q

Why are new fasting guidelines being followed?

A

Postoperative dehydration contributes to postoperative complications such as nausea and vom

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15
Q

Why should patients remove jewellery before going into the OR

A

Electrical arcs and burns, fires, hygiene

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16
Q

What group of patients are often prescribed H2 receptor antagonists

A

Patients at increased risk of gastric regurgitation

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17
Q

What medication can be prescribed for patients with anxiety that also helps induce sedation

A

Benzodiazepines

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18
Q

Why are some patients prescribed antiemetics

A

Increases gastric emptying, decrease nausea

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19
Q

Why are some patients prescribed anticholingergics

A

Decreased oral secretions and prevents bradycardia

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20
Q

Why should patients not wear nail polish

A
  • impedes accurate pulse oximetry
  • unable to visualise cyanosis in nail bed
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21
Q

State 4 goals of the preoperative nursing assessment

A
  • establish baseline data to compare pre and post op
  • confirm patient id
  • determine readiness
  • determine physiological factors
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22
Q

List 6 components of a nursing assessment

A
  • correct patient identification
  • past history
  • social history
  • meds
  • physical
  • diagnostics
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23
Q

List 6 components of the preoperative checklist

A
  • patient ID
  • Consent
  • Allergies
  • patient prep
  • communication aids
  • belongings
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24
Q

Describe the intraoperative phase

A

Extends from the time the patient is admitted to the theatre holding bay until the patient is transported to the PACU for recovery

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25
Why is the OR cold
Inhibits pathogen growths and decreases risk of pathogen transfer
26
State the 3 distinct zones of the OR
Unrestricted Semi restricted Restricted
27
The type of anaesthesia provided to a patient depends on
- type of surgical procedure - muscle relaxation required? - patients past medical history - current patient wellness - equipment available - skills of OR team
28
What is the Goal of anaesthesia
Manage the biological response to surgery while minimising patient risks
29
Describe general
- loss of sensation W loc - sedation, analgesia and muscle relaxants - loss of sympathetic NS reflexes - advanced airway management
30
Describe regional
- loss of sensation without LOC - nerve block achieved with admin of a local anaesthetic into a nerve bundle
31
4 examples of regional anaesthetic
Spinal Epidural Caudal Peripheral
32
List the 4 examples of peripheral regional anaesthetic
Axillary Supraclavicular Popliteal Femoral Sciatic
33
What is the Dermatome
Area of skin supplied by a single spinal nerve
34
What is the bromage score
Used to assess movement ability of the lower extremities after regional anaesthesia administered.
35
What is the main difference between procedural sedation and general
In PS patient generally able to maintain airway
36
List the 4 stages of anaesthesia
1. Analgesia 2. Excitement 3. Surgical anaesthesia 4. Medullary paralysis
37
Describe analgesia
- from beginning of induction with propofol to unconsciousness - patient has a decreased awareness of pain - regular respiration - ends with LOC
38
Describe the excitement phase
- from LOC to beginning of regular Resp - enhanced reflexes - HR and BP may rise
39
What happens in plane 1 of anaesthesia
Light anaesthesia
40
What happens in plane 2 of surgical anaesthesia
Loss of blink reflex, no longer responsive to non painful stim
41
What happens in plane 3
Deep anaesthesia, no movement, AW and breathing assistance needed
42
Describe plane 4
Diaphragmatic Resp only, cardi and Resp support needed
43
What is medullary paralysis
OD Pupils fixed and dilated Breathing and circulatory collapse
44
Name 6 keys to preventing adverse events post surgery and anaesthetic
- close observation and monitoring - regular reassessments - early recognition of deterioration - prompt escalation - administration of meds
45
Describe the frequency of reassessments in the first 4 hours
Every 3o mins until stable Hourly for the next 4 hours Every 4 hours for the next 24 hours
46
List 6 immediate potential postoperative complications
- Threatened airway - Brady or tacky pnoea or cardia - hypoxamia - hypertension - GCS drop - uncontrolled pain - bleeding
47
List 5 ongoing nursing management during post op care
- post operative movement - elimination - GIT - wound healing - rest and comfort - emotional and spiritual support
48
List 3 pain assessment tools
PQRST FLACC Wong baker
49
PQRST
Precipating factors Quality Radiation Site and severity Timing and treatment
50
What does FLACC stand for
Face Legs Activity Crying Consolability
51
List 5 non pharm management options for pain
- position changes - support with pillows - ice packs - support - patient education
52
What is paralytic ileus
Temporary impairment of gastric and bowel mobility which can occur after surgery
53
Causes of paralytic ileus
- limited dietary intake prior to surgery - handling of intestines during surgery - hypokalaemia - prolonged opioid analgesic administration
54
List 5 things to assess patient for if they have had spinal epidural and caudal anaesthetic
- severe headache - Resp depression - hypotension - sensory response - motor response
55
What is the main function of hyperbaric oxygenation
Increases capacity of blood to carry oxygen to the tissues
56
Benefits of HBO
Increased oxygenation assists in CR and improves leukocyte migration and phagocytosis as well as fibroblast function For CW reduced inflammation, oedema, inhibition of infection
57
How does NPWT work
Using a device to apply constant controlled negative pressure to a wound that is filled with a drainage sponge and sealed with an occlusive dressing.
58
NPWT has three mechanisms of action, name them
Mechanical tension on the tissue Macro deformation and wound contraction Micro deformation and mechanical stretch perfusion
59
Describe penrose drain tubes
Soft ribbon like tube that drains onto gauze or into a pouch. Open drain = higher infection
60
Describe Jackson Pratt drains
Closed drainage system where fluid is collected into a small soft bulb.
61
Describe redivac and hemovac drains
Closed drainage Circular device connected to a tube that sits inside the body Removes fluid by creating a low pressure suction in the tube.
62
Nurse initiated interventions to manage pain
Holistic approach Combo of pharm and non pharm interventions Multimodal approach Interpersonal approach Evaluate effectiveness Manage side effects Educate the patient and carer
63
What is the action of paracetamol
Prostaglandin synthesis inhibition in the CNS
64
AE of paracetamol
Nausea Dyspepsia Renal dysfunction Liver failure
65
Nursing care consideration of paracetamol
Metabolised by liver Chronic liver disease Alcohol dependency patients
66
Action of ibuprofen
Inhibit cox-1 non selectively and selectively binds to cox -2 decreasing inflammation and pain
67
NCC of ibuprofen
- current use of aspirin or NSAIDs contra - caution with warfarin - use of antacids
68
What reverses Opiod OD
Naloxone
69
Action of morph
On CNS and smooth muscle Binds with specific opiod receptors (mu , delta and kappa) and decrease pain transmission in the spinal cord.
70
NCC with morph
Resp depression Early admin of laxatives Confusion
71
Action of oxycodone
Semi synthetic opiod Actions similar to morph Shorter acting than morph
72
How do antiemetics work
Blocking the neurotransmitters in the vominiting centre, the cerebral cortex and the CTZ
73
Action of ondansetron
Blocks the initiation of the vomiting reflex by activating vagaries afferents via 5HT3 receptors in the brain
74
Describe the action of metoclopramide
Stimulates motility of UGIT without stimulating gastric, billary or pancreatic secretions Increases tone and amplitude of gastric contractions, relaxes the pyloric sphincter and increases peristalsis of the duodenum and jejunum resulting in accelerated gastric emptying and intestinal transit.
75
ADV of PCAs
- avoid analgesic peaks and troughs - less delay - empowerment - opiod blood conc maintained within therapeutic ranges
76
List 3 PCA pump modes
PCA mode only Continuous infusion CI with additional demand

2226 (2 decks)

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