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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
Q

Why is the OR cold

A

Inhibits pathogen growths and decreases risk of pathogen transfer

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26
Q

State the 3 distinct zones of the OR

A

Unrestricted
Semi restricted
Restricted

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27
Q

The type of anaesthesia provided to a patient depends on

A
  • type of surgical procedure
  • muscle relaxation required?
  • patients past medical history
  • current patient wellness
  • equipment available
  • skills of OR team
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28
Q

What is the Goal of anaesthesia

A

Manage the biological response to surgery while minimising patient risks

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29
Q

Describe general

A
  • loss of sensation W loc
  • sedation, analgesia and muscle relaxants
  • loss of sympathetic NS reflexes
  • advanced airway management
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30
Q

Describe regional

A
  • loss of sensation without LOC
  • nerve block achieved with admin of a local anaesthetic into a nerve bundle
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31
Q

4 examples of regional anaesthetic

A

Spinal
Epidural
Caudal
Peripheral

32
Q

List the 4 examples of peripheral regional anaesthetic

A

Axillary
Supraclavicular
Popliteal
Femoral
Sciatic

33
Q

What is the Dermatome

A

Area of skin supplied by a single spinal nerve

34
Q

What is the bromage score

A

Used to assess movement ability of the lower extremities after regional anaesthesia administered.

35
Q

What is the main difference between procedural sedation and general

A

In PS patient generally able to maintain airway

36
Q

List the 4 stages of anaesthesia

A
  1. Analgesia
  2. Excitement
  3. Surgical anaesthesia
  4. Medullary paralysis
37
Q

Describe analgesia

A
  • from beginning of induction with propofol to unconsciousness
  • patient has a decreased awareness of pain
  • regular respiration
  • ends with LOC
38
Q

Describe the excitement phase

A
  • from LOC to beginning of regular Resp
  • enhanced reflexes
  • HR and BP may rise
39
Q

What happens in plane 1 of anaesthesia

A

Light anaesthesia

40
Q

What happens in plane 2 of surgical anaesthesia

A

Loss of blink reflex, no longer responsive to non painful stim

41
Q

What happens in plane 3

A

Deep anaesthesia, no movement, AW and breathing assistance needed

42
Q

Describe plane 4

A

Diaphragmatic Resp only, cardi and Resp support needed

43
Q

What is medullary paralysis

A

OD
Pupils fixed and dilated
Breathing and circulatory collapse

44
Q

Name 6 keys to preventing adverse events post surgery and anaesthetic

A
  • close observation and monitoring
  • regular reassessments
  • early recognition of deterioration
  • prompt escalation
  • administration of meds
45
Q

Describe the frequency of reassessments in the first 4 hours

A

Every 3o mins until stable
Hourly for the next 4 hours
Every 4 hours for the next 24 hours

46
Q

List 6 immediate potential postoperative complications

A
  • Threatened airway
  • Brady or tacky pnoea or cardia
  • hypoxamia
  • hypertension
  • GCS drop
  • uncontrolled pain
  • bleeding
47
Q

List 5 ongoing nursing management during post op care

A
  • post operative movement
  • elimination
  • GIT
  • wound healing
  • rest and comfort
  • emotional and spiritual support
48
Q

List 3 pain assessment tools

A

PQRST
FLACC
Wong baker

49
Q

PQRST

A

Precipating factors
Quality
Radiation
Site and severity
Timing and treatment

50
Q

What does FLACC stand for

A

Face
Legs
Activity
Crying
Consolability

51
Q

List 5 non pharm management options for pain

A
  • position changes
  • support with pillows
  • ice packs
  • support
  • patient education
52
Q

What is paralytic ileus

A

Temporary impairment of gastric and bowel mobility which can occur after surgery

53
Q

Causes of paralytic ileus

A
  • limited dietary intake prior to surgery
  • handling of intestines during surgery
  • hypokalaemia
  • prolonged opioid analgesic administration
54
Q

List 5 things to assess patient for if they have had spinal epidural and caudal anaesthetic

A
  • severe headache
  • Resp depression
  • hypotension
  • sensory response
  • motor response
55
Q

What is the main function of hyperbaric oxygenation

A

Increases capacity of blood to carry oxygen to the tissues

56
Q

Benefits of HBO

A

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
Q

How does NPWT work

A

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
Q

NPWT has three mechanisms of action, name them

A

Mechanical tension on the tissue
Macro deformation and wound contraction
Micro deformation and mechanical stretch perfusion

59
Q

Describe penrose drain tubes

A

Soft ribbon like tube that drains onto gauze or into a pouch. Open drain = higher infection

60
Q

Describe Jackson Pratt drains

A

Closed drainage system where fluid is collected into a small soft bulb.

61
Q

Describe redivac and hemovac drains

A

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
Q

Nurse initiated interventions to manage pain

A

Holistic approach
Combo of pharm and non pharm interventions
Multimodal approach
Interpersonal approach
Evaluate effectiveness
Manage side effects
Educate the patient and carer

63
Q

What is the action of paracetamol

A

Prostaglandin synthesis inhibition in the CNS

64
Q

AE of paracetamol

A

Nausea
Dyspepsia
Renal dysfunction
Liver failure

65
Q

Nursing care consideration of paracetamol

A

Metabolised by liver
Chronic liver disease
Alcohol dependency patients

66
Q

Action of ibuprofen

A

Inhibit cox-1 non selectively and selectively binds to cox -2 decreasing inflammation and pain

67
Q

NCC of ibuprofen

A
  • current use of aspirin or NSAIDs contra
  • caution with warfarin
  • use of antacids
68
Q

What reverses Opiod OD

A

Naloxone

69
Q

Action of morph

A

On CNS and smooth muscle
Binds with specific opiod receptors (mu , delta and kappa) and decrease pain transmission in the spinal cord.

70
Q

NCC with morph

A

Resp depression
Early admin of laxatives
Confusion

71
Q

Action of oxycodone

A

Semi synthetic opiod
Actions similar to morph
Shorter acting than morph

72
Q

How do antiemetics work

A

Blocking the neurotransmitters in the vominiting centre, the cerebral cortex and the CTZ

73
Q

Action of ondansetron

A

Blocks the initiation of the vomiting reflex by activating vagaries afferents via 5HT3 receptors in the brain

74
Q

Describe the action of metoclopramide

A

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
Q

ADV of PCAs

A
  • avoid analgesic peaks and troughs
  • less delay
  • empowerment
  • opiod blood conc maintained within therapeutic ranges
76
Q

List 3 PCA pump modes

A

PCA mode only
Continuous infusion
CI with additional demand

2226 (2 decks)

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