Mod 8 Flashcards
preoperative care takes place from…
the time clients are scheduled for surgery until care is transferred to the operating suite.
preoperative care includes thorough data collection of the clients..
physical, emotional, and psychosocial status prior to surgery
surgery may be performed for?
restorative, curative, palliative, or cosmetic purpose
whose responsibility is it to obtain consent after discussing procedure risks and benefits?
Responsibility of the provider. The nurse IS NOT TO obtain the consent for the provider IN ANY circumstance
can the nurse provide new information or additional information not previously given by the provider
no. They can claify and info that remains unclear after the explanation but nothing new that has not been covered by the provider first.
palliative surgery
to relieve pain or complications Ex; to remove a metastatic rumor from the abdomen that is causing considerable pain
curative surgery
alleviates (cures) a problem as when a gallbladder that is full of stones causing blockage or pain is removed
who is at risk of higher complications of surgery and why
the infant and the elder because of either immature body systems or a decline in function of various body systems.
light amplification by the stimulated emission of radiation
laser surgery
what surgery is common and is often combined with microscopic, endoscopic, and robotic enhanced procedures.
laser surgery
allows the use of endoscopes with high-resolution video cameras passed through a very small incision for an ever increasing variety of surgical procedures.
fiberoptic surgery
this surgery is operated from a nearby comp, views magnified three dimensional images of surgical field on screen, magnification up to 12 times that of normal. remote controlled instruments are inserted through small incisions.
robotic surgery
what are some advantages of robotic surgery
has rock-steady hands, providing precision that is beyond human dexterity. Only small incisions are needed, the pt has less pain postoperatively and requires less time to heal. less scaring and fewer infections
what decreases complications?
a normal fluid and electrolyte balance
how long should pts avoid smoking before surgery
24 hours before surgery or 3 to 4 weeks before
what is the benefits of not smoking before surgery
increases the action of the lungs defense mechanisms and makes more hemoglobin available to carry oxygen during surgery and improves wound healing
what may cause nutritional deficiencies and bleeding problems
long term alcohol use
PAT
preadmission testing
what is included in the PAT interview
health history, identification of risk factors, pt and family teaching, discharge planning, and necessary referrals to social work, support groups, and educational programs. Ask about previous problems with anesthesia or malignant hyperthermia
how much water can the pt take with their medications the morning of surgery when they are to be NPO
1 ounce
atelectasis
collapse of the lung caused by hop ventilation or mucous obstruction preventing some alveoli from opening and being fully ventilated
what helps prevent atelectasis
deep breathing, by expanding and ventilating the lungs.
arterial blood gases
obtain baseline levels and detect pH and oxygenation abnormalities
bleeding time
detect prolonged bleeding problem
blood urea nitrogen (BUN) or creatine
detect kidney problem
complete blood cell count (CBC)
detect anemia, infection, clotting problem
electrolytes
detect potassium, sodium, chloride imbalances
fasting blood glucose
detect abnormalities, monitor diabetes control
partial thromboplastin time
detect clotting problem
international normalized ratio (INR)
detect clotting problem, monitor warfarin therapy
type and cross match
identify blood type to match blood for possible transfusion
urinalysis
detect infection, abnormalities.
what are the main priorities of care postoperatively?
maintaining airway, latency and ventilation and monitoring circulatory status
most surgeons postpone surgery if the pts ? is to low
hemoglobin level
the dictated report must be in the record…
before the pt goes to surgery
stasis
stoppage of flow
thrombophlebitis
blood clot causing inflammation of a vessel
how long should deep breathing and coughing be performed after general anesthesia
every 2 hours for 72 hours
most preoperative medications are given ? in the surgical holding area
intravenously
what are the two purposes of a consent
1) protects the patient from unauthorized procedures
2) protects the physician, anesthesiologist, hospital, and hospital employees from claims of performance of unauthorized procedures.
the type of anesthesia and the anesthetic agents are ordered by the anesthesia prouder with input from?
the pt and the physician
what are the two types of anesthesia
general and local (regional)
this anesthesia causes the pt to lose sensation, consciousness, and reflexes. it acts directly on the nerve impulses along the nerve where it is injected, resulting in the loss of sensation to a region of the body without the loss of consciousness
General
general anesthesia is commonly given by ?
IV or inhalation
maintenance of anesthesia is accomplished by using ?
inhalation agents
rare hereditary muscular disease that can be triggered by some types of general anesthetic agents.
malignant hyperthermia
what is the most effective med for malignant hyperthermia?
Dantrolene sodium (dantrium) - muscle relaxant - must be kept readily available in the OR
achieved by injecting the medication into the tissue where the incision is to be made
local infiltration
done by injecting the local agent along a nerve that carries impulses in the region where anesthesia is desired
regional block
injection of a local agent into a nerve at a specific point
nerve block
done by placing a tourniquet on an extremity to remove the blood and then injecting the local agent into the extremity
Bier block
is a series of injections surrounding the surgical area
field block
is injection of a local agent into an area around the spinal nerves.
spinal or epidural block
used mainly for lower extremity and lower abdominal surgery. both motor and sensory function is blocked.
spinal and epidural blocks
what happens if the block travels too far upward?
respiratory depression
results from leakage of cerebrospinal fluid (CSF) from the needle puncture hole in the dura that does not close when the needle is withdrawn.
Postdural puncture headache(reduces pressure on the spinal cord and brain causing a headache)
purposeful minimal sedation that does not cause the complete loss of consciousness. pts still have control of their own airway. Medications such as sedatives, hypnotics and opiods are given to produce this sedation
conscious sedation
what are priority areas of pt assessment
ensuring a patent airway, preventing falls and injury from uncontrolled movements, respiratory status, vital signs including Sao2, level of consciousness and responsiveness, surgical site incision/dressing/drainage tubes, and pain level and pain management
begins when the pt is admitted to the PACU or a nursing unit and ends with the pts postoperative evaluation in the physicians office
postoperative phase
what medication is used to relieve shivering or shaking from anesthesia
Demerol (meperidine)
what med is used for nausea or vomiting
antiemetics
includes level of consciousness; orientation to person, place time and event; pupil size and reaction to light; and motor and sensory function
neurologic assessment
IV analgesics usually have a ? duration than IM analgesics
shorter
the edges of the wound are approximated with staples or sutures. scaring is minimal
first intention healing
wound is usually left open and allowed to heal by granulation. scaring is usually extensive with prolonged healing
second intention healing
an infected wound is left open until there is no evidence of infection and the wound is then surgically closed
third intention healing
wound problems can include
hematoma, infection, dehiscense, and evisceration
dehiscence
sudden bursting open of a wounds edges which may be preceded by and increase in serosanguineous drainage
eviscreation
is the viscera spilling out of the abdomen ( feels like something let loose or gave away)
what aids in healing dehisced surgical incisions that resist healing?
VAC - vacuum assisted closure
after abdominal surgery, GI assessment should include?
monitoring vital signs, the return of flatus, the return of appetite, first bowel movement, any nausea or vomiting, or signs of ileum, such as distention, bloating, and cramps.
after abdominal surgery, peristalsis, bowel sounds and flatus is usually stopped or absent for how many hours?
24 - 72 hours
pt will return to normal bowel elimination patterns and report freedom from gas pains and constipation within how many days
3 - 4 days post op
what is the primary purpose of most IV fluids?
to provide hydration ( most iv solutions do not provide enough nutrients or calories to prevent malnutrition)
discharge planning begins during the ? and continues…
preadmission testing;
after admission to ensure that the pt is ready for a timely discharge.
clinical discharge criteria include?
stable vital signs, no bleeding, no nausea or vomiting, and controlled pain that is not severe. Depending on the type of surgery the pt may be required to void before leaving.
list in order what is done in the intraoperative phase
1) pt transported to holding room where circulating nurse verifies pts ID and that all preoperative orders have been accomplished
2) anesthesiologist or nurse anesthetist start IV if not already in place
3) surgical consent for is checked to eunsure pt is being prepared for correct surgery
4) surgical site is verified and marked BEFORE medications are given
5) PREop meds are administered
6) when OR is ready pt is transferred
when is anesthesia begun?
as the pt is being draped. further skin preparation is done at this time also
warming the pt before an operation can reduce the risk of surgical wound infection by what percent
57%
vital signs are taken every ? - ? mins in the post anesthesia care unit (PACU)
5-15 mins until stable
anesthesia recovery period usually takes ? hours
2-6 hours
what form of scoring system may be used to determine readiness for transfer? activity, respiration, circulation, consciousness, and skin color are each given a score of 1-3. total score of 9-10 usually indicates the pt is ready for transfer.
form of the “Aldrete” scoring system.
when can the post anesthesia care same day surgery pt be discharged?
when vital signs are stable, the pt is allowed to sit up and then is ambulated. “when able to ambulate unassisted, the pt may be discharged if ital signs are stable”
how long is the usual recovery time in the same day surgery unit
1-4 hours
(post-op care)
vital signs and careful assessment are performed every ? mins for the 1st hour, every ? mins for the next 2 hours, every ? mins for the next 4 hours, and then every ? hours until the pt is totally recovered from anesthesia and vital signs have returned to normal
15mins;
30mins;
60 mins(hour);
4
the pt must be positioned ? or ? to prevent aspiration, if not contraindicated, until fully recover, alert, and with the swallowing reflex intact
on the side;
with the head turned to the side
why is it important to encourage the pt to drink plenty of fluids even those containing caffeine?
the fluids and caffeine raise the vascular pressure at the spinal puncture site and help seal the hole
what is the expected amount of drainage postoperatively for :
urine, gastric contents, wound drainage, and T-tube, bile
urine = 500-700mL for 1-2 days post-op, then 1500-2500mL thereafter depending of intake
Gastric contents = up to 1500mL/day
Wound drainage = variable with procedure and type of drain
T-tube, bile = up to 500mL
atelectasis
collapse of alveoli in the lungs
what occurs when lack of movement or of position change causes stasis of secretions, which become a breeding ground for bacteria?
hyopstatic pneumonia
coughing may be contraindicated for pts that have had what kind of surgery?
hernia repair, eye, ear, or brain surgery
what can be especially helpful to prevent atelectasis and hypoventilation?
use of an incentive spirometer
report arterial oxygen saturation (Sao2) readings below ? to the physician
92%
when the procedure involved an extremity or the pelvic area, what pulse do you check for each full assessment?
check the distal or peripheral pulse.
swelling at the surgical site can…
compress vessels and decrease blood flow distal to the area.
what can an increase in pulse indicate
internal bleeding is occurring, but can also signify incomplete pain control
blood pressure falling below normal baseline level may indicate…
major bleeding
if the urine flow is less than ?mL/kg/hr report it to the charge nurse. If flow is less than ? mL over a 2-hour period, notify the surgeon.
5mL/kg/hr;
60mL
no potassium additive should be given until the urine flow is at least…? why?
5 mL/kg/hr;
Potassium may cause hyperkalemia if kidney function is not adequate.
