Nursing W&H 12, ATI 88 Flashcards
define surgery
use of instruments during an operation to treat injuries, disease, and deformities
surgical procedure are named according to:
1-involved body organ part or location
2-the suffix that describes what is done during the procedure
-ectomy
removal by cutting
-orrhaphy
suture of or repair
-oscopy
looking into
-ostomy
formation of a permanent artificial opening
-otomy
incision or cutting into
-plasty
formation or repair
purpose of aesthetic surgery
requested by pt. for improvement (breast augmentation)
purpose of diagnostic surgery
to obtain tissue samples, make an incision, or use a scope to make a diagnosis
purpose of preventative surgery
removal of tissue before it causes a problem
purpose of curative surgery
removal of diseased or abnormal tissue
purpose of palliative surgery
alleviation of symptoms when disease cannot be cured
main priorities for care in the PACU
- maintain airway
- ventilation
- monitor circulatory status
postoperative client outcomes
- vital signs will return to baseline levels
- client will perform post-op exercises
- client will be free from injury
risk factors for post-op complications
- immobility (pressure ulcer, thrombophlebitis)
- anemia (blood loss, healing factors)
- hypovolemia (tissue perfusion)
- respiratory disease (respiratory compromise)
- immune disorder (risk for infection, delayed healing)
- diabetes (delayed wound healing)
- malnutrition
- obesity (wound healing, dehiscence, evisceration)
- age (respiratory, cardiovascular, and renal changes with age)
signs that pt. is ready to be transfered out of PACU
- stable vital signs
- no evidence of bleeding
- return of reflexes (gag, cough, swallow)
- wound draining is to a minimum
- urine output at least 30 mL/hr
post-op diagnostic procedure and purpose of each
- CBC=infection, immune status
- Hgb and Hct=fluid status, anemia
- Electrolyte levels=electrolyte balance
- serum creatinine=renal status
- ABGs=oxygenation status
post-op positioning of pillows
- Under feet to promote venous return
- NOT UNDER KNEES (this will decrease venous return
risk factors for dehiscence or evisceration
obesity
coughing
moving without splinting
diabetes mellitus
A client who had a hysterectomy resumed a regular diet earlier in the day. Now the client is reporting nausea and has vomited once. Which action should the nurse take?
monitor for bowel sounds
A nurse is caring for a pt. who had abdominal surgery 7 days ago. The nurse observes serosanguineous drainage from the incision site. Which actions should the nurse take at this time
report findings to the charge nurse
reinforce coughing, but avoid forceful coughing
splint the incision upon movement
place pt in supine position with hips/knees bent
A nurse is caring for a pt. who is post-op gastric resection. What actions should the nurse take
- Apply pneumatic compression stockings bilaterally
- administer pain med 30 minutes prior to ambulation
- encourage the pt to perform leg exercises every 1 to 2 hr
what are the phase in the surgical process
- -preoperative=begins with decision for surgery and ends with transfer to the OR
- -intraoperative=begins with the transfer to OR and ends with admission to PACU
- -postoperative=begins with admission to PACU and continues until recovery is complete
- -all together=preoperative
what is the primary role as LPN in preoperative phase
- assist in data collection
- reinforce explanations and instructions
- provide emotional and psychological support
what is the physicians role in preoperative phase
- obtain a medical history
- perform a physical exam
- orders diagnostic tests
when preparing a pt. for surgery, the goal is:
to identify an implement actions that reduce surgical risk factors
nutrition is important. diet must be high in what to promote healing
protein=tissue repair and healing
vitamin C=collagen formation
zinc=tissue growth, skin integrity, and cell mediated immunity
what does smoking and alcohol do for pt. getting surgery
- increases the pt’s risk.
- smoking thickens and increases the amount of lung sections
- reduces the action of cilia that remove sections
- decreases wound healing
- alcohol causes liver damage, creates bleeding problems, fluid volume imbalances, drug metabolism alterations, interacts with medications
purpose of deep breathing
- helps prevent the development of atelectasis
- repeat hourly while awake
define atelectasis
collapse of the lung caused by hypoventilation or mucous obstruction preventing some alveoli from opening and being fully ventilated
purpose of incentive spirometry
- increases lung volume
- alveoli expansion
- venous return
- prevents atelectasis
preoperative consent
- PHYSICIAN is responsible to obtain consent
- valid for 30 days after signing
- can be taken back
consent has 2 purposes
- protects the pt from unauthorized procedures
- protects the physician, anesthesiologist, hospital, hospital employees from claims of performance of unauthorized procedures
what 3 elements does a consent involve
1–physician must explain about diagnosis, proposed treatment, who will perform it, likely outcome, possible risks, complications, prognosis, answer questions
2–consent must be signed BEFORE analgesics or sedatives are given
3–consent must be voluntarily
pts who are unable to give consent are:
unconscious
mentally incompetent
minors
received analgesics or drugs that alter CNS
preoperative checklist items
- id band placed
- hospital gown
- vital signs taken
- make up, nail polish, artificial nails removed
- remove hair pins, wigs, jewelry(because of edema)
- dentures, contact lenses, prostheses removed
- glasses and hearing aids go with pt if unable to communicate w/o them
- test results reviewed
- anti-embolism devices applied
- pts asked to void BEFORE sedation
purpose of anti-anxiety and sedative hypnotics as preoperative med
sedation; anxiety reduction
diazepam, valium, ativan
purpose of anticholinergics as preoperative med
secretion reduction
purpose of antiemetic as preoperative med
control nausea and vomiting. may be effective into the postoperative period
purpose of alkalinizing agent
increase gastric pH
purpose of antibiotics as preoperative med
prevent postop infection
purpose of histamine antagonists as preop med
reduction of acidic gastric secretions to prevent acid aspiration pneumonitis
post op patient hospital room preparation
bed linen should be changed place disposable pads on bottom sheet apply life sheet have extra blankets available fanfold top cover obtain extra pillows have emesis basin ready have tissues and washcloths in room have urinal or bedpan available
if pt requires body hair removal for surgery, what should you do
removed with electric clippers or depilatory. shaving should be avoided. can cause micro-abrasion and colonize microorganism
what are the two types of anesthesia
general
local
general anesthesia
pt loses sensation, consciousness, and reflexes
acts directly on the CNS
local anesthesia
blocks nerve impulses along the never where it is injected. loss of sensation to a region of the body w/o the loss of consciousness
malignant hyperthermia
- -rare hereditary muscular disease
- -triggered by some types of general anesthetic agents
- -history of anesthetic problems
- history of heat stroke
- -metabolism in the muscles is increased
- -very high fever, rigidity, tachycardia, tachypnea, hypertension, dysrhtmias, hyperkalemia, metabolic respiratory acidosis, cyanosis,
- -give 100% O2, pt must be cooled with ice and infusions. Dantrolene sodium (Dantrium) must be given. Relaxes muscle. Most effective med for malignant hyperthermia
