Module 9 Flashcards
Why is pre-op education and discharge planning important?
Pre-op: improves patient compliance and outcomes, improves patient satisfaction.
D/C planning: improves patient outcomes, reduces length of stay and reduces incidence of readmission.
When is the consent form signed?
Before the procedure, after consultation with the surgeon and anaesthetist, and once patient understanding has been ensured.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Colonoscopy
Endoscopic examination of the large bowel and distal part of the small bowel with a camera.
Standard care + bowel prep. Pre-med may or may not be ordered.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Total Hip Replacement
Diseased or damaged portion of the neck of the femur is replaced with metal or ceramic components.
Standard care + education, analgesia plan, physio plan and DVT prophylaxis.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Appendicectomy
Surgery to remove the appendix. Usually emergency - infection risk.
Standard care + open or lap?, hair clipping, ultrasound/CT scan, DVT prophylaxis, antibiotic prophylaxis.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Gastrectomy
Removal of part or all of the stomach.
Standard care + education, analgesia plan, physio plan, DVT prophylaxis, nutrition plan (tube vs TPN), nutritional supplements, bowel care plan, social work/psychology
Define the following surgical procedures and identify specific pre-operative preparation for each.
Arthroscopy
Examination of inside of a joint (knee, elbow) using a special illuminating instrument inserted through a small incision. An arthroscope can diagnose or treat conditions such as torn cartilage, torn ligaments or arthritis.
Standard care + education, analgesia plan, physio plan.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Mastectomy
Removal of the great - unilaterally or bilaterally.
Standard care + education, analgesia plan, DVT prophylaxis, physio plan, social work/psychology, breast nurse referral, wound management plan.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Rhinoplasty
Repair or reshaping of the nose for cosmetic reasons or to correct a structural defect.
May require mupiricin ointment to clear MRSA.
Standard care + expectations and understanding of the procedure.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Salpingectomy
Removal of one or both of the fallopian tubes.
Standard care + social work/psychology, expectations and understanding of procedure.
Define the following surgical procedures and identify specific pre-operative preparation for each.
Laparotomy
Surgical incision into the abdomen. Commonly performed to examine abdominal organs and aid diagnosis.
Standard care + education, DVT prophylaxis, analgesia plan.
Complete the following grid of pre-operative and post-operative medications.
Metoclopramide
Drug:
Metoclopramide: antiemetic, prokinetic.
Action:
Dopamine antagonist.
Side effects: akathisia drowsiness dizziness headache extra-pyramidal side effects
Complete the following grid of pre-operative and post-operative medications.
Temazapam
Drug:
Temazapam: Given as pre-med relaxant.
Action:
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and anti-epileptic effects.
Side effects: drowsiness over sedation lightheadedness memory loss hyper salivation ataxia slurred speech dependence effects on vision (blurriness, impaired tracking) hiccups hypotension arrhythmias respiratory arrest
Complete the following grid of pre-operative and post-operative medications.
Midazolam
Drug:
Midazolam: sedative during procedure; low dose used as antiemetic.
Actions:
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and anti-epileptic effects.
Side effects: drowsiness over sedation lightheadedness memory loss hyper salivation ataxia slurred speech dependence effects on vision (blurriness, impaired tracking) hiccups hypotension arrhythmias respiratory arrest
Complete the following grid of pre-operative and post-operative medications.
Ondansetron
Drug: Ondansetron - treatment of N&V associated with cancer chemotherapy, post-op and radiotherapy.
Actions: CNS & PNS 5HT3 receptor blockade
Side effects: constipation headache dizziness transient rise in hepatic aminotransferases
Complete the following grid of pre-operative and post-operative medications.
Oxycodone
Drug: Oxycodone.
Actions:
Opioid analgesics mimic endogenous opioids by activating opioid receptor in the CNS and PNS to produce analgesia, respiratory depression, sedation and constipation.
They reduce transmission of the pain impulse by acting pre and post synaptically in the spinal cord, and by modulating the descending inhibitory pathways from the brain. Cough suppression occurs in the medullary centre of the brain.
Side effects: N&V dyspepsia drowsiness dizziness headache orthostatic hypotension itch dry mouth mitosis urinary retention constipation
Complete the following grid of pre-operative and post-operative medications.
Clexane
Drug: Clexane
Actions:
Inactivate clotting factors IIa (thrombin) and Xa by binding to antithrombin III.
Prevention of VTE in surgical patients and in medical patients bedridden due to acute illness.
Treatment of venous thrombosis.
Prevention of extracorporeal thrombosis during haemodialysis.
Treatment of acute STEMI, non-STEMI and unstable angina.
Side effects:
bleeding
brusing and pain at injection site
hyperkalaemia
mild reversible thrombocytopenia
skin necrosis (usually at injection site)
osteoporosis and alopecia with long-term use
allergic reactions including urticaria and anaphylaxis
What is the purpose of giving a pre-med?
To reduce anxiety
Why are TED/anti-embolic stockings used?
Long, tight-fitting ‘socks’ that keep mild graduated pressure on the legs.
Proper size and fit is important in order for stockings to be effective.
They help the blood to constantly move in the leg providing good circulation, therefore preventing DVT.
Why is it important to assess vital signs pre-operatively?
To provide a baseline to compare to postoperatively. May indicate preoperative issues which may delay administration of operative procedure.
What is the reason for fasting patients before a surgical procedure?
Reduce risk of aspiration.
When should a written consent be obtained?
Surgical, medical, radiology, oncology and endoscopy treatments/procedures requiring general, regional or local anaesthesia or IV sedation.
Invasive procedures or treatments where there are known significant risks or complications (e.g. blood transfusions)
Sterilisation of a minor and application of ECT.
Administration of medication with known high-risk complications or new, unusual medications that may have risks.
Drugs administered under the Special Access Scheme.
Participation in clinical trials and medical research.
Why should the consent be signed before giving a pre-med?
Patient needs to be cognitively competent to sign a consent form, pre-medication diminishes as most produce some level of sedation and alteration in cognitive processes.
Why is it important for patients to cease taking aspirin and NSAIDs (according to the doctor’s advice) for up to 2 weeks before any surgery?
Reduce risk of haemorrhage.
What are your priorities on receiving a postoperative patient to the ward and why?
Assess: Breathing and administer supplemental oxygen Vital signs LOC Pain and administer analgesia N&V and administer antiemetics IV site/s Drainage tubes Urine output
In addition:
Position patient to enhance comfort and in an appropriate and safe position for the type of surgery they have had. Reassure patient and family.
Give patient call bell.
Follow specific policy and post-op instructions set by surgeon and health organisation.
What are some of the complications that may occur in your patient post-operatively?
Infection Venous thromboembolism (DVT, PE) Pneumonia ventilation--perfusion mismatch Hypoventilation (e.g. from opioid medication) Haemorrhaging Atelectasis Pain N&V Oliguria Post-operative pyrexia (common in THR) Pressure sores Constipation Delirium
How would you as a nurse detect these complications?
Frequent monitoring of vital signs, drains, IVs and other invasive devices, observation of signs exhibited by patient such as shivering, grimacing, guarding, GCS, wound assessment and pain assessment.
