NRSR 22 Unit 2: Care of the Surgical Patient Flashcards
Purpose of Surgery
- Diagnostic: Breast mass biopsy; exploratory laparotomy
- Ablative: Removal of diseased body part
3 Palliative: Reduce intensity of symptoms. eq. Colostomy, resection of nerve roots - Reconstructive: Restore function or appearance: eq. Scar revision
- Procurement for transplant: eq. Kidney, liver
- Constructive: Restore function lost or reduced
eq. Closure of atrial septal defect in heart, repair of cleft palate - Cosmetic: To improve personal appearance eq. nose, eyes
Subjective Assessment of Pre-Operative Patient
-Psychosocial Assessment Anxiety, Fear, Hope -Past Health History -Allergies -Review of Symptoms -Medications Prescribed, Recreational, CATs
Objective Assessment of Pre-Opertative Patient
- Physical Exam
- Diagnostics
Common Peroperative Lab and Diagnostic Tests
-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
Nursing Preparation of Pre-Op Patient:
Educational
- Sensory Information: bright lights, noisy machines, cold drugs
- Procedural Information: Clothing to wear, fluid & food restrictions, pain control IV lines
- Process Information: General flow of surgery
Preoperative Fasting Recommendations
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
3 conditions that must be met for informed consent to be valid
- There must be adequate disclosure of the diagnosis.
- Patient must demonstrate clear understanding and comprehension.
- Patient must give consent voluntarily.
Purposes of pre-operative medications
- Prophylactic antimicrobials - antibiotics
- Antiemetics - decrease nausea and vomiting
- Sedatives - Opioids, benzodiazepines
- Anticholinergics - reduce secretions
Additional medications
- Beta blockers - H2 blockers to control BP and cardiac problems
- Antidiabetics
3 Areas of the Surgery Department
- Unrestricted - holding area, locker room, nursing station. Street clothes
- Semirestricted - surrounding support areas, corridors. surgical attire, cover all head & facial hair
- Restricted - OR, scrub sink areas, clean core. Surgical attire and mask
Psychosocial Assessment of Preoperative Patient
- Situational changes:
- identify support system
- Define degree of personal control, independence
- Determine level of hope and anticipation - Concerns with the unknown:
- Identify areas/degrees of anxiety and fears
- identify expectations, changes health status - Past Experiences
- Review previous surgical experiences
- Determine whether they were positive or negative
- Identify current perception of surgical procedure - 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
Priorities in the Postanesthesia care unit assessment
- Airway - Obstruction, hypoxemia, Aspiration, bronchospasm
- Breathing - Pulmonary edema & embolism, hypoventilation, atelectasis, pneumonia
- Circulation: hypotension, HTN, dysrhythmia, DVT, compartment syndrome
- Neurologic - delirium, delayed emergence
- Genitourinary - voiding, retention, oliguria
- Surgical Site - infection, abscess, evisceration, drainage
- Pain