Mod 6 - Perioperative focus for Midterm

Question 1

What are the factors increasing surgical risk

Answer 1

• Pre-existing medical conditions and medications such as cardiac, COPD, renal disease, diabetes, liver disease
• Age – very young and very old
• Nutrition/Malnurition
• Obesity – reducing respiratory and cardiac functions
• Immunocompetence - pt with aviation or chemo therapy or after organ transplantation have increased risk of infection
• Fluid and electrolyte imbalance
• Pregnancy – major systems are affected during pregnancy

Question 2

How Nutrition/Malnurition increase surgical risk? Pt is prone to poor tolerance of..

Answer 2

Normal tissue repair and resistance to infection depend on adequate nutrients; surgery intensifies this need
- pt is prone to poor tolerance of anaesthesia, negative nitrogen balance, delayed blood clotting mechanisms, infection, poor wound healing, and the potential for multiple organ failure

Question 3

Bleeding disorders increase risk of

Answer 3

hemorrhaging during and after surgery

Question 4

How does diabetes mellitus increase risk of surgery

Answer 4

increase chance of infection and impaired wound healing
- (due to altered glucose metabolism and associated circulatory impairment, Stress of surgery may cause increase in blood glucose)

Question 5

How does Heart disease (recent myocardial infarction, dysrhythmias, heart failure) and peripheral vascular disease increase risk of surgery

Answer 5

o Stress of surgery causes increased demands on myocardium to maintain cardiac output.
o General aesthetic agents depress cardiac function

Question 6

how does obstructive sleep apnea increase risk of surgery

Answer 6

Administration of opioids increases risk of airway obstruction postoperatively.
o Patients will desaturate as revealed by drop in oxygen saturation

Question 7

How do Upper respiratory infection increase risk of surgery

Answer 7

increase risk of respiratory complications during anaesthesia (e.g. pneumonia and spasm of laryngeal muscles)

Question 8

how does Liver disease increase risk of surgery

Answer 8

• alters metabolism and elimination of drugs administered during surgery
• impairs wound healing and clotting time because of alterations in protein metabolism

Question 9

what medical condition/symptom Predisposes patient to fluid and electrolyte imbalances and may indicate underlying infection?

Answer 9

Fever

Question 10

How does Chronic respiratory disease (emphysema, bronchitis, asthma) increase risk of surgery

Answer 10

o Reduces patients means to compensate for acid-base alterations
o Anaesthetic agents reduce respiratory function, increasing risk for severe hypoventilation

Question 11

how do • Immunological disorders (leukemia, HIV, bone marrow depression, and use of chemotherapeutic drugs or immunosuppressive agents) increase risk of surgery

Answer 11

Increase risk of infection and delayed wound healing after surgery

Question 12

how does Abuse of street drugs increase risk of surgery

Answer 12

o May have underlying disease (HIV, Hepatitis), which can affect response of anaesthesia and surgery and the healing process

Question 13

how does Chronic pain increase risk of surgery

Answer 13

Regular use of pain meds may = higher tolerance, reduced effect from repeated doses of the same analgesics class
o	Increased doses of analgesics may be required to achieve post-op pain control

Question 14

what is regional anesthesia

Answer 14

blocks pain in an area of the body, such an arm or leg. A common type is epidural anesthesia, which is often used during childbirth.

Question 15

what is General anesthesia

Answer 15

makes you unconscious. You do not feel any pain, and you do not remember the procedure afterwards.

Question 16

a patient wirh pre-existing bronchitis who has abnormal breath sounds and a productive cough will be at risk for? (nursing diagnosis)

Answer 16

ineffective airway clearance

Question 17

what are the Post-op exercises you should teach your pt? and why are they important?

Answer 17

Deep Breathing, Coughing, and Moving After Surgery

- help your breathing, clear your lungs, and lower your risk of pneumonia.

Question 18

what does the Positive expiratory pressure (PEP) device do?

Answer 18

Creates pressure in the lungs and keeps airways from closing, it helps move mucus up

Question 19

1) The incentive spirometer is used to provide information about pt’s…?
2) It is used to increase?
3) may assist in strengthening…?
4) Prevents..?

Answer 19

1) inspiratory effort by measuring the air flow and the air volume
2) inspiratory volume
3) strengthening inspiratory muscle performance
4) Prevents atelectasis

Question 20

Ambulation post-op helps prevent

Answer 20

DVT

Question 21

 Post-op patients will generally be put on either mechanical or chemical VTE prophylaxis.
What is chemical and what is mechanical?
they are all helping with..?

Answer 21

 Chemical - either heparin, enoxaparin, dalteparin injection.
 Mechanical - SCD’s/Anti-embolism stockings
 All helping with circulation and prevention of blood clots forming

Question 22

what vitals will you see in a hemorrhage complication? what should you assess?

Answer 22

o You will see drop in BP, hypotension and tachycardia
o Look at surgical site – dressing or bed saturated in sanguiness drainage?
o Check vital signs and LOC

Question 23

How do you assess for pneumonia, atelectasis?

Answer 23

Breathing effectively? Are there signs of pneumonia – are they requiring more oxygen? Can you ascultate breath sounds to the base of their lungs or not?

Question 24

Why is it important to assess pain post-op and keep it managed?

Answer 24

Want to keep the px tolerable for pt to participate in rehabilitation
If pt in too much pain – they don’t want to take deep breaths and that predisposes them to Pneumonia
 Don’t want to get up and move because it’s too painful – at risk for VTE/DVT