Notes Ch: 50 - Surgical Patient Care Flashcards
What are the perioperative phases?
- Preoperative
- Intraoperative
- Postoperative
What are some reasons the preoperative phase be considered the “most important”?
- Patient procedure education
- Consent acquired
- History acquired
- Physical assessment performed
- Safety/Risk analysis and confirmation
- Procedure confirmation (Time Out)
Where is ambulatory surgery performed and what are its benefits?
Ambulatory is generally performed in a clinic
Advantages
- In/Out the same day; no hospital stay
- Laparoscopic; minimally invasive surgery
- Utilizes anesthesia drugs that are quickly metabolized and have less SFX
- Decreased risk of HAIs (nosocomial infections)
- Quicker; Cost saving to patient and institution
What are the factors to remember for patient concent?
- MD education of PT on procedure
- cannot come from NURSE
- PT needs to acknowledge undertanding
- MD and RN must sign/witness concent
What are the three main components to patient history?
- Medical
- Surgical
- Social
What are some things to pay attention to in the medical history? Why?
- Allergies
- to be aware of possible reactions (ex. anaphalactic shock)
- Medications
- need to know prescribed, otc and illegal to minimize adverse reactions
- Diabetes
- factors into surgical prep for Glucose levels
- post op infection risks
What are we assessing in the patient’s surgical history?
- Related surgery
- Reason for surgery
- Emergent status of surgery
What are some components that make up a patient’s social history?
- Support resources (family and friends)
- Smoking/drinking
- Lifestyle; active/sedentary
- Religous considerations
Why is the social history important?
- Helps assess patient support network,
- healing/infection factors,
- religous factors that may dictate care.
What does NPO mean and what does it help the patient avoid?
- Nothing by mouth
- Risk of aspiration
If a diabetics fluids are not maintained (in leiu of fasting), what could happen?
The patient can become hypoglycemic.
What are some ways hypoglycemia could effect a post-op patient?
- Slow/poor wound healing
- Higher risk of infection
- Coud develop secondary infections such as:
- pneumonia,
- urinary tract infections or
- sepsis
What are some indications that there is hemorrhaging?
- Low blood pressure
- Tachycardia
- Tachypnea
How do bleeding disorders increase risk of surgery?
Increased risk of hemorrhaging pre/post surgery
How does Diabetes Mellitus increase risk of surgery?
- Altered glucose metabolism and circulatory impairment -> increased susceptibility to infection
- Stress of surgery -> increased blood glucose
How does Heart Disease increase risk of surgery?
- Surgery = increased demand on the myocardium of the heart
- General anesthesia depresses cardiac function
How does Obstructive Sleep Apnea increase risk of surgery?
Opioids increase risk of post op airway obstruction (respiratory depression) which results in drop of O2 sat
How does a URI increase risk of surgery?
Imposes a risk of respiratory complications complications under anesthesia
How does Liver Disease increase risk of surgery?
- Alters metabolism and elimination of drugs given during surgery
- Alterations in protein metabolism -> poor clotting and wound healing
How does Fever increase risk of surgery?
- Creates risk for fluid and electrolyte imbalance
- Indicator of underlying infection
How does Chronic Respiratory Disease increase risk of surgery?
- Reduces Pt’s ability to compensate for acid-base imbalance
- Anesthesia reduces respiratory function –> risk of severe hypoventilation
How do Immunological Disorders increase risk of surgery?
- Increased risk of infection
- Delayed healing
How does the abuse of street drugs increase risk of surgery?
- Pt that abuse drugs may also have underlying conditions that will interfere w/ the healing process
- Ex. HIV or hepatitis
How does chronic pain increase risk of surgery?
- These Pts might regularly use pain meds, which increases their tolerance
- Increased doses of analgesics necessary to manage post op pain
What is a PCA pump, and what are the factors to keep in mind regarding it?
- Patient Controlled Analgesia
- Self-managed pain care “on demand”
- Unit is pre-programmed with dosages/limits preventing overdosing
- Usage would be explained pre-op
- If opioid, It could slow down RR
What tool to help exercise the lungs post-op?
Intraspirometer
How is the instraspirometer typicall used and what is the benefit?
- 10 times per hour
- Helps keep the lungs in shape to prevent atelectasis
