NRSR 22 Unit 2: Care of the Surgical Patient Flashcards

1
Q

Purpose of Surgery

A
  1. Diagnostic: Breast mass biopsy; exploratory laparotomy
  2. Ablative: Removal of diseased body part
    3 Palliative: Reduce intensity of symptoms. eq. Colostomy, resection of nerve roots
  3. Reconstructive: Restore function or appearance: eq. Scar revision
  4. Procurement for transplant: eq. Kidney, liver
  5. Constructive: Restore function lost or reduced
    eq. Closure of atrial septal defect in heart, repair of cleft palate
  6. Cosmetic: To improve personal appearance eq. nose, eyes
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2
Q

Subjective Assessment of Pre-Operative Patient

A
-Psychosocial Assessment
   Anxiety, Fear, Hope
-Past Health History
-Allergies
-Review of Symptoms
-Medications
   Prescribed, Recreational, CATs
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3
Q

Objective Assessment of Pre-Opertative Patient

A
  • Physical Exam

- Diagnostics

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4
Q

Common Peroperative Lab and Diagnostic Tests

A

-ABGs, pulse oximetry
-Blood glucose
-BUN, Creatinine
-Chest X-Ray
-Blood Count
-ECG
-Electrolytes
-hCG - pregnancy
-Liver function tests
-PT, PTT, INR, Platelet count - coagulation status
-Pulmonary function studies
Serum albumin - Nutritional status
Type and Crossmatch - blood availability
Urinalysis - Renal status, hydration, UTI

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5
Q

Nursing Preparation of Pre-Op Patient:

Educational

A
  1. Sensory Information: bright lights, noisy machines, cold drugs
  2. Procedural Information: Clothing to wear, fluid & food restrictions, pain control IV lines
  3. Process Information: General flow of surgery
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6
Q

Preoperative Fasting Recommendations

A
Clear liquids - 2 hrs
Breast milk - 4 hrs
Milk, formula - 6 hrs
Light meal (e.g. toast and clear liquids) - 6 hrs
Regular meal - 8 hrs
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7
Q

3 conditions that must be met for informed consent to be valid

A
  1. There must be adequate disclosure of the diagnosis.
  2. Patient must demonstrate clear understanding and comprehension.
  3. Patient must give consent voluntarily.
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8
Q

Purposes of pre-operative medications

A
  1. Prophylactic antimicrobials - antibiotics
  2. Antiemetics - decrease nausea and vomiting
  3. Sedatives - Opioids, benzodiazepines
  4. Anticholinergics - reduce secretions

Additional medications

  1. Beta blockers - H2 blockers to control BP and cardiac problems
  2. Antidiabetics
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9
Q

3 Areas of the Surgery Department

A
  1. Unrestricted - holding area, locker room, nursing station. Street clothes
  2. Semirestricted - surrounding support areas, corridors. surgical attire, cover all head & facial hair
  3. Restricted - OR, scrub sink areas, clean core. Surgical attire and mask
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10
Q

Psychosocial Assessment of Preoperative Patient

A
  1. Situational changes:
    - identify support system
    - Define degree of personal control, independence
    - Determine level of hope and anticipation
  2. Concerns with the unknown:
    - Identify areas/degrees of anxiety and fears
    - identify expectations, changes health status
  3. Past Experiences
    - Review previous surgical experiences
    - Determine whether they were positive or negative
    - Identify current perception of surgical procedure
  4. Knowledge Deficit
    - Identify amount and type of information patient requires
    - Assess understanding of the surgical procedure
    - Identify the accuracy of information the patient has received from HCP and family and friends
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11
Q

Priorities in the Postanesthesia care unit assessment

A
  1. Airway - Obstruction, hypoxemia, Aspiration, bronchospasm
  2. Breathing - Pulmonary edema & embolism, hypoventilation, atelectasis, pneumonia
  3. Circulation: hypotension, HTN, dysrhythmia, DVT, compartment syndrome
  4. Neurologic - delirium, delayed emergence
  5. Genitourinary - voiding, retention, oliguria
  6. Surgical Site - infection, abscess, evisceration, drainage
  7. Pain
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