Peri-operative Care Flashcards
Describe the classification of urgency for extent of surgery
- Degree of emergency -
- Degree of urgency - surgery needed within 20 - 30 hours
- Required - within a few weeks / months - ex. thyroid disorder, cataracts
- Elective - scheduled in advance, not medically urgent / necessary
- Optional - not needed - ex. Brest implants, cosmetic surgery
Describe pre-admission testing
- Makes sure the patient is ready to receive surgery
- A lot done outside of hospital
- Initiates initial preoperative assessment
- Initiates teaching appropriate to patient’s needs
- Involves family in interview
- Verifies completion of preoperative diagnostic testing
- Verifies understanding of surgeon-specific preoperative orders
- Discusses/ reviews advanced-directive document
- Begins discharge planning by assessing patient’s need for postoperative transportation and care
What patient demographics are focused on during pre-admission testing?
- PMH / H & P - good for 30 days
- Consent forms - good for 30 days
- Labs - baseline blood testings / liver and kidney function if over the age of 50
- Diagnostic testing EKG if over the age of 50
- Risk factors
What factors can affect surgical outcomes?
- Lifestyle factors
- Culture / religion - consent to receiving blood
- Developmental factors
- Socioeconomic factors - affording rehab / medications
- Physiological factors
What lifestyle factors can affect surgical outcomes?
- Nutrition
- Activity / exercise
- Substance abuse
What physiological factors can affect surgical outcomes?
- Respiratory disorders
- Cardiovascular disorders
- Diabetes
- Renal and liver disease
- Hematological disorders
- Medications
Describe advanced aging effects on surgical outcomes
Old cts are at risk due to declining physiological status; very young are at risk due to immature physiol. Status; see p. 1600, Table 49-4 on “Factors that Place the Older Adult at Risk During Surgery”
Describe obesity effects on surgical outcomes
Reduces ventilatory & cardiac function; HTN, CAD, DM, & CHF are common in obese pts; also dvp more post-op complications
Describe malnutrition effects on surgical outcomes
at risk for poor tolerance to anesthesia, delayed clotting mechanisms, infection, poor wound healing because normal tissue repair and resistance to infx depend on adequate nutrition; if elective surgery, will try to reverse this; if emergent/urgent surgery, will correct postop
Describe dehydration / electrolyte imbalance effects on surgical outcomes
a person who is hypovolemic (dehydrated) or has electrolyte alterations preop is at significant risk during and after surgery r/t fluid/electrolyte shifts that takes place after surgery (Na+ and H2O are retained and K+ is lost) potential for legal dysrhythmias r/t low K+ level; risk is increased with those with renal, GI, or CV diseases
Describe respiratory disorder effects on surgical outcomes
COPD; anesthetic agents reduce respiratory function, increasing risk for hypoventilation
Describe diabetes effects on surgical outcomes
Stess of surgery causes increase demands on the heart to maintain CO; general anesth. Depress cardiac function
Describe renal / liver dysfunction effects on surgical outcomes
increased susceptibility to infx and may impair wound healing from altered glucose metabolism; stress of surgery can increase BG levels
Describe alcoholism effects on surgical outcomes
alter the metabolism/elimination of drugs administered during surgery; with liver problems, alter wound healing & clotting time r/t alterations in protein metabolism
Alcoholism: altered liver function and usually malnourished; cts with hx of illegal drug use may require higher-than-normal dose of anesthetics r/t cross-tolerance and also increase in pain med dosages post-op.
What types of herbal medications can affect surgical outcomes?
- Ginseng
- Ginger
- St. John’s wort
- Echinacea
** Cause increased bleeding time
