Notes Ch: 50 - Surgical Patient Care

Question 1

What are the perioperative phases?

Answer 1

• Preoperative
• Intraoperative
• Postoperative

Question 2

What are some reasons the preoperative phase be considered the “most important”?

Answer 2

• Patient procedure education
• Consent acquired
• History acquired
• Physical assessment performed
• Safety/Risk analysis and confirmation
• Procedure confirmation (Time Out)

Question 3

Where is ambulatory surgery performed and what are its benefits?

Answer 3

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

Question 4

What are the factors to remember for patient concent?

Answer 4

• MD education of PT on procedure
  
  • cannot come from NURSE
• PT needs to acknowledge undertanding
• MD and RN must sign/witness concent

Question 5

What are the three main components to patient history?

Answer 5

1. Medical
2. Surgical
3. Social

Question 6

What are some things to pay attention to in the medical history? Why?

Answer 6

• 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

Question 7

What are we assessing in the patient’s surgical history?

Answer 7

• Related surgery
• Reason for surgery
• Emergent status of surgery

Question 8

What are some components that make up a patient’s social history?

Answer 8

• Support resources (family and friends)
• Smoking/drinking
• Lifestyle; active/sedentary
• Religous considerations

Question 9

Why is the social history important?

Answer 9

• Helps assess patient support network,
• healing/infection factors,
• religous factors that may dictate care.

Question 10

What does NPO mean and what does it help the patient avoid?

Answer 10

• Nothing by mouth
• Risk of aspiration

Question 11

If a diabetics fluids are not maintained (in leiu of fasting), what could happen?

Answer 11

The patient can become hypoglycemic.

Question 12

What are some ways hypoglycemia could effect a post-op patient?

Answer 12

• Slow/poor wound healing
• Higher risk of infection
• Coud develop secondary infections such as:
  
  • pneumonia,
  • urinary tract infections or
  • sepsis

Question 13

What are some indications that there is hemorrhaging?

Answer 13

• Low blood pressure
• Tachycardia
• Tachypnea

Question 14

How do bleeding disorders increase risk of surgery?

Answer 14

Increased risk of hemorrhaging pre/post surgery

Question 15

How does Diabetes Mellitus increase risk of surgery?

Answer 15

• Altered glucose metabolism and circulatory impairment -> increased susceptibility to infection
• Stress of surgery -> increased blood glucose

Question 16

How does Heart Disease increase risk of surgery?

Answer 16

• Surgery = increased demand on the myocardium of the heart
• General anesthesia depresses cardiac function

Question 17

How does Obstructive Sleep Apnea increase risk of surgery?

Answer 17

Opioids increase risk of post op airway obstruction (respiratory depression) which results in drop of O₂ sat

Question 18

How does a URI increase risk of surgery?

Answer 18

Imposes a risk of respiratory complications complications under anesthesia

Question 19

How does Liver Disease increase risk of surgery?

Answer 19

• Alters metabolism and elimination of drugs given during surgery
• Alterations in protein metabolism -> poor clotting and wound healing

Question 20

How does Fever increase risk of surgery?

Answer 20

• Creates risk for fluid and electrolyte imbalance
• Indicator of underlying infection

Question 21

How does Chronic Respiratory Disease increase risk of surgery?

Answer 21

• Reduces Pt’s ability to compensate for acid-base imbalance
• Anesthesia reduces respiratory function –> risk of severe hypoventilation

Question 22

How do Immunological Disorders increase risk of surgery?

Answer 22

• Increased risk of infection
• Delayed healing

Question 23

How does the abuse of street drugs increase risk of surgery?

Answer 23

• Pt that abuse drugs may also have underlying conditions that will interfere w/ the healing process
• Ex. HIV or hepatitis

Question 24

How does chronic pain increase risk of surgery?

Answer 24

• These Pts might regularly use pain meds, which increases their tolerance
• Increased doses of analgesics necessary to manage post op pain

Question 25

What is a PCA pump, and what are the factors to keep in mind regarding it?

Answer 25

• 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

Question 26

What tool to help exercise the lungs post-op?

Answer 26

Intraspirometer

Question 27

How is the instraspirometer typicall used and what is the benefit?

Answer 27

• 10 times per hour
• Helps keep the lungs in shape to prevent atelectasis