objective 7 Flashcards
Period that constitutes the surgical experience. Includes three phases
perioperative
what are the 3 phases of perioperative?
preoperative
intraoperative
postoperative
the period from the decision for surgery until the
patient is transferred into the operating room
preoperative phase
the period from when the patient is transferred
to the operating room to the admission to postanesthesia care unit
(PACU)
intraoperative phase
the period that begins with admission to the
PACU and ends with follow-up evaluation in the clinical setting or at
home
postoperative phase
what are the surgical classifications?
diagnostic
cure or reparative
reconstructive/cosmetic
prevention
biopsy, exploratory
diagnostic
removal of appendix or tumor
wound repair
cure or reparative
facelift
reconstructive/cosmetic
premalignant
prevention
what are the surgical classifications?
exploration
palliative
Laparoscopy to determine extent or nature of disease
exploration
- Relieve pain
- Also classified according to the degree of urgency
palliative
without delay, life saving
emergent
prompt attention, within 24-30 hrs
urgent
within a few weeks or months
required
failure to not have, not catastrophic
elective
patient preference
optional
Voluntary and written informed
consent from the patient is necessary
before nonemergent surgery can be
performed
informed consent
what does the preoperative teaching guide include?
nutritional and fluids status
dentition
drug or alcohol use
respiratory and cardiovascular status
hepatic and renal function
endocrine function
immune function
previous med use
psychosocial factors
any deficiency should be corrected before
surgery
nutritional and fluid status
decayed or dental prosthesis may be dislodged during
intubation
dentition
malnutrition, alcohol withdrawal postoperatively
drug or alcohol use
postponed if infection, smokers
urged to stop 4-8 weeks prior, breathing exercises and incentive
spirometer postoperatively
respiratory and cardiovascular status
medications, anesthetic, toxins adequately
metabolized
hepatic and renal function
diabetes to be monitored closely before, during and after surgery
endocrine function
allergies and sensitivities, immunosuppressed at risk of infection
immune function
what does preoperative teaching consist of?
position changes and movement
pain management
reducing anxiety and fear, support of coping
special considerations related to outpatient surgery
include when and where, what to bring, what to leave at home, what to wear
reminded not to eat or drink and which meds they are table to take
what are the preoperative nursing interventions?
Patient safety is a primary concern
NPO—current practice guidelines
(nurse must explain about
aspiration)
Bowel (enema or laxative)and skin
preparation (shaving with electric
clippers)
what are the common preoperative laboratory tests?
Hemoglobin
White blood cell
count (WBC)
Blood typing and
cross matching
(screening)
Serum electrolytes
Xrays
Pulmonary fuction
tests
Prothrombin time
(PT) and partial
thromboplastin time
(PTT)
Bilirubin
Liver enzymes
Urine analysis
Blood urea nitrogen
(BUN) and creatinine
what are preop meds?
- Anticholinergics – decrease secretions ( Atropine sulfate)
- Benzodiazepines/Antianxiety drugs (ativan)
- Histamine – 2 receptor antagonists – decrease gastric
acidity (Zantac) - Opiods/Narcotics – pain (Demerol & Morphine)
- Sedatives – promote sleep (versed)
- Tranquilizers – reduce nausea & produce sedation
(Valium,Dalmane) - Antibiotics
- Antemetics
- Eye Drops
who does the surgical team consist of?
patient
anesthesiologist
surgeon
registered nurse
circulating nurse
scrub nurse
- Commonly experiences fear and anxiety
- Faces risk of infection
patient
- Assesses patient before surgery, selects
anesthesia, administers it, intubates the
pt, manages problems related to
administration of the anesthetic agent,
supervises the pts condition throughout - Monitors vital signs, ECG, blood gas
levels, blood pH and alveolar gas
concentrations
anesthesiologist
- Performs surgical procedure
- Heads the surgical team
surgeon
verifies
consent, coordinates the team,
ensures cleanliness, proper
temperature, safe function of
equipment, availability of
supplies and materials
circulating nurse
often performed by a
practical nurse who has a perioperative certificate. Completes
surgical hand scrub, setting up sterile
tables, assisting surgeon, preparing
sutures and special equipment,
counting equipment and supplies
scrub nurse
what are the potential AE of surgery and anesthesia?
- Allergic reaction
- Cardiac dysrhythmia
- CNS agitation, seizures, respiratory
depression - Oversedation or undersedation
- Agitation or disorientation (elderly)
- Hypotension
- Hypothermia
- Thrombosis
- Electric shock or burns, laser burns
- Drug toxicity, faulty equipment,
human error
is a controlled
environment designed to maximize
infection control and provide a seamless
flow of patients, personnel, and operative
instruments, equipment, and supplies. The
suite is divided into three distinct areas:
unrestricted, semirestricted, and restricted
surgical suite
Designed to maintain surgical asepsis
Divided into unrestricted, semirestricted, and
restricted zones
Specifics of surgical attire are recommended
by Association of PeriOperative Registered
Nurses (AORN)
Equipment is sterile
Airborne bacteria controlled by air flow
surgical environment
what are the stages of general sedation?
stage I
stage II
stage III
stage IV
beginning anesthesia
- Ringing, buzzing, difficulty moving
stage I
excitement
- Struggling, shouting, and talking
- May require restraint
stage II
surgical anesthesia
- Patient is unconscious, quiet; respirations are easy
stage III
medullary depression
stage IV
what are the types of regional anesthesia?
epidural
spinal
local conductive blocks
injected into the space surrounding the dura mater
epidural
injected into the subarachnoid space at the lumbar level
* Can produce a spinal headache (keep patient well hydrated and
lying flat to prevent)
spinal
to reduce anxiety and control pain during a
procedure
* IV administration of sedatives and analgesics
moderate sedation
monitored sedation
* Must be prepared to convert to general anesthesia
* Used for minor surgeries and critically ill who may not tolerate
general anesthesia
monitored anesthesia care MAC
The preferred method of choice in any surgical procedure
local anesthesia
what are the potential complications of intraoperative care?
N/V
anaphylaxis
hypoxia and respiratory complications
hypothermia
malignant hyperthermia
what is the initial postanaesthesia care unit assessment?
airway: patency, airway, ET tube
breathing: rate, breath sounds, O2 stats, O2
circulation: EKG, BP, Temp, Pulse, skin color
neurological: LOC, orientation, sensory/motor
gastro/urinary: intake/output
surgical site: dressing/drainage
pain: incision
shock
what are the respiration complications?
airway obstruction
pulmonary edema
atelectasis
aspiration
pulmonary embolism
hypoventilation
snoring, wheezing, distress
airway obstruction
decreased breath sounds, decreased O2 stats
atelectasis
crackles, decreased O2 stats, cough with sputum
pulmonary edema
decrease O2 saturation, hypoxemia, spasms
aspiration
tachypnea, dyspnea, tachycardia, hypotension
pulmonary embolism
decreased respiratory rate or effort, hypoxemia, increased PaCO2
hyperventilations
what are the potential alteration in cardiac function?
- Hypotension ( decrease in BP) – disorientation, LOC, chest pain,
oliguria, and anuria - Hypertension ( increase in BP)
- Dysrhthmias
- DVT
- Pulmonary embolism
- Syncope - Fainting
what are the potential alterations in neurological function?
● Hypoxia
* Anaesthetic agents
* Bladder distension
* Immobility
* Sensory and cognitive impairments
* Inadequate pain control
* Electrolyte abnormalities
* Presence of an endotracheal tube
* Polypharmacy
* Dehydration and malnutrition
* State of anxiety before surgery
what does the complete pain assessment consist of>
Location
* Intensity, assessed using a reliable, valid pain assessment tool
(e.g., verbal descriptor, numeric rating, or visual analogue)
* Quality (e.g., neuropathic pain may be described as “burning”
or “shooting”)
* Factors that relieve and aggravate
* Effect of pain on function
* Comfort–function goal (e.g., for the postoperative patient, link
pain control to the ability to deep-breathe, turn, or ambulate)
what are the GI problems?
constipation and diarrhea
N/V
aspiration
wound dehiscence
increase intracranial pressure
increased cardiovascular demand
flatus
ileus
paralytic ileus
what are the potential alterations in urinary function?
- Decreased urinary output
- Urinary Retention
- Impaired sphincter control
what are the potential integumentary complications>
Surgical site infections ( SSIs)
SSIs are caused by :
* Introduction of endogenous bacteria (from the patient) into the
wound
* Introduction of exogenous contamination (from the surgical
environment) into the wound
* Inability of the individual to resist infection due to reduced immune
capacity (disease, malnutrition, medication) or other factors
Indicators as follows:
* Purulent discharge
* Isolation of organisms from wound fluid or tissue
* Pain, tenderness, local edema, warmth
* Physician or health care team member diagnosis
what does a wound assessment consist of>
Appearance: Note the colour of wound, bruising, redness, and
approximation of the incision.
* Size: Note the length, width, depth and shape of the wound
and any signs of the wound opening (i.e., dehiscence or
evisceration).
* Exudate: Check the wound for exudate type (e.g., watery,
purulent), odour, and amount. A small amount of serous
drainage is common, and it changes from sanguineous (red) to
serosanguineous (pink) to serous (clear yellow). Draining will
decrease over time.
* Edema: Excessive swelling may indicate wound complications.
* Pain: Sudden onset or persistent severe incisional pain may
indicate infection, hemorrhage, or hematoma.
* Drains: Note the placement and security of drain or tube.
Check the collection device; empty as required and document.
