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Med-Surg Nursing > objective 7 > Flashcards

objective 7 Flashcards

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1
Q

Period that constitutes the surgical experience. Includes three phases

A

perioperative

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2
Q

what are the 3 phases of perioperative?

A

preoperative
intraoperative
postoperative

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3
Q

the period from the decision for surgery until the
patient is transferred into the operating room

A

preoperative phase

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4
Q

the period from when the patient is transferred
to the operating room to the admission to postanesthesia care unit
(PACU)

A

intraoperative phase

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5
Q

the period that begins with admission to the
PACU and ends with follow-up evaluation in the clinical setting or at
home

A

postoperative phase

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6
Q

what are the surgical classifications?

A

diagnostic
cure or reparative
reconstructive/cosmetic
prevention

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7
Q

biopsy, exploratory

A

diagnostic

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8
Q

removal of appendix or tumor
wound repair

A

cure or reparative

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9
Q

facelift

A

reconstructive/cosmetic

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10
Q

premalignant

A

prevention

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11
Q

what are the surgical classifications?

A

exploration
palliative

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12
Q

Laparoscopy to determine extent or nature of disease

A

exploration

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13
Q
  • Relieve pain
  • Also classified according to the degree of urgency
A

palliative

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14
Q

without delay, life saving

A

emergent

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15
Q

prompt attention, within 24-30 hrs

A

urgent

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16
Q

within a few weeks or months

A

required

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17
Q

failure to not have, not catastrophic

A

elective

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18
Q

patient preference

A

optional

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19
Q

Voluntary and written informed
consent from the patient is necessary
before nonemergent surgery can be
performed

A

informed consent

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20
Q

what does the preoperative teaching guide include?

A

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

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21
Q

any deficiency should be corrected before
surgery

A

nutritional and fluid status

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22
Q

decayed or dental prosthesis may be dislodged during
intubation

A

dentition

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23
Q

malnutrition, alcohol withdrawal postoperatively

A

drug or alcohol use

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24
Q

postponed if infection, smokers
urged to stop 4-8 weeks prior, breathing exercises and incentive
spirometer postoperatively

A

respiratory and cardiovascular status

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25
Q

medications, anesthetic, toxins adequately
metabolized

A

hepatic and renal function

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26
Q

diabetes to be monitored closely before, during and after surgery

A

endocrine function

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27
Q

allergies and sensitivities, immunosuppressed at risk of infection

A

immune function

28
Q

what does preoperative teaching consist of?

A

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

29
Q

what are the preoperative nursing interventions?

A

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)

30
Q

what are the common preoperative laboratory tests?

A

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

31
Q

what are preop meds?

A
  • 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
32
Q

who does the surgical team consist of?

A

patient
anesthesiologist
surgeon
registered nurse
circulating nurse
scrub nurse

33
Q
  • Commonly experiences fear and anxiety
  • Faces risk of infection
A

patient

34
Q
  • 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
A

anesthesiologist

35
Q
  • Performs surgical procedure
  • Heads the surgical team
A

surgeon

36
Q

verifies
consent, coordinates the team,
ensures cleanliness, proper
temperature, safe function of
equipment, availability of
supplies and materials

A

circulating nurse

37
Q

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

A

scrub nurse

38
Q

what are the potential AE of surgery and anesthesia?

A
  • 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
39
Q

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

A

surgical suite

40
Q

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

A

surgical environment

41
Q

what are the stages of general sedation?

A

stage I
stage II
stage III
stage IV

42
Q

beginning anesthesia
- Ringing, buzzing, difficulty moving

A

stage I

43
Q

excitement
- Struggling, shouting, and talking
- May require restraint

A

stage II

44
Q

surgical anesthesia
- Patient is unconscious, quiet; respirations are easy

A

stage III

45
Q

medullary depression

A

stage IV

46
Q

what are the types of regional anesthesia?

A

epidural
spinal
local conductive blocks

47
Q

injected into the space surrounding the dura mater

A

epidural

48
Q

injected into the subarachnoid space at the lumbar level
* Can produce a spinal headache (keep patient well hydrated and
lying flat to prevent)

A

spinal

49
Q

to reduce anxiety and control pain during a
procedure
* IV administration of sedatives and analgesics

A

moderate sedation

50
Q

monitored sedation
* Must be prepared to convert to general anesthesia
* Used for minor surgeries and critically ill who may not tolerate
general anesthesia

A

monitored anesthesia care MAC

51
Q

The preferred method of choice in any surgical procedure

A

local anesthesia

52
Q

what are the potential complications of intraoperative care?

A

N/V
anaphylaxis
hypoxia and respiratory complications
hypothermia
malignant hyperthermia

53
Q

what is the initial postanaesthesia care unit assessment?

A

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

54
Q

what are the respiration complications?

A

airway obstruction
pulmonary edema
atelectasis
aspiration
pulmonary embolism
hypoventilation

55
Q

snoring, wheezing, distress

A

airway obstruction

56
Q

decreased breath sounds, decreased O2 stats

A

atelectasis

57
Q

crackles, decreased O2 stats, cough with sputum

A

pulmonary edema

58
Q

decrease O2 saturation, hypoxemia, spasms

A

aspiration

59
Q

tachypnea, dyspnea, tachycardia, hypotension

A

pulmonary embolism

60
Q

decreased respiratory rate or effort, hypoxemia, increased PaCO2

A

hyperventilations

61
Q

what are the potential alteration in cardiac function?

A
  • Hypotension ( decrease in BP) – disorientation, LOC, chest pain,
    oliguria, and anuria
  • Hypertension ( increase in BP)
  • Dysrhthmias
  • DVT
  • Pulmonary embolism
  • Syncope - Fainting
62
Q

what are the potential alterations in neurological function?

A

● 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

63
Q

what does the complete pain assessment consist of>

A

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)

64
Q

what are the GI problems?

A

constipation and diarrhea
N/V
aspiration
wound dehiscence
increase intracranial pressure
increased cardiovascular demand
flatus
ileus
paralytic ileus

65
Q

what are the potential alterations in urinary function?

A
  • Decreased urinary output
  • Urinary Retention
  • Impaired sphincter control
66
Q

what are the potential integumentary complications>

A

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

67
Q

what does a wound assessment consist of>

A

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.

Med-Surg Nursing (13 decks)

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