Peri-Operative Nursing Care and Patient Assessment Flashcards
1
Q
The setting in which a surgical procedure may be safely and effectively performed is influenced by the:
A
- Complexity of the surgery
- Potential complications
- General health status of the patient
2
Q
Surgery- treatment of disease abnormalities or injury by manipulative and operative methods
A
Diagnosis Cure Palliation Prevention Exploration Cosmetic improvement
3
Q
Types of surgery
A
- Diagnosis (Biopsy, extent of the disease, lymph node biopsy)
- Cure (El,imation or repair, ruptured appendix)
- Palliation (To relieve symptoms and not cure, obstructions. E.g. to remove tumours)
- Prevention (E.g. removal of mole)
- Exploration (Surgical examination to determine nature and extent)
- Cosmetic improvement (changing breast shape, eye lift)
4
Q
Surgical Settings
A
- Surgical clients enter the acute care setting in different stages of health and with different levels of preparedness
- Emergency- unexpected urgency
- Must be performed immediately to save a life, limb or body function
- Urgent- be performed within 24-48 hours
- Elective- surgery is a planned event
- The ability to quickly establish rapport with the client and maintain a professional relationship is essential component to preoperative care
5
Q
Types of anesthetics
A
- General- Given IV/Inhaled to make the patient unconscious
- Unresponsive to a stimulus including pain
- Suppress the respiratory center and disturb normal circulatory reflexes
- Loss of protective reflexes to protect the airway (e.g. Gag, cough, swallow)
- Regional- region of the body is anesthetized: spinal, epidural
- Local- small area is numb
- Conscious sedation- patient is sedate, there is some depression of awareness, patient cans till speak, respond to commands
6
Q
Preoperative nursing responsibilities
A
- Gather data to identify risk factors and plan care to ensure patient safety throughout the surgical experience
- Knowledge of the nature of the disorder
- Coexisting disease processes or medical processes
- Identify the patient’s response to the stress of the surgery
- Potential complications, risks with the procedure
7
Q
Pre-operative stage: Nurse’s role
A
- Identifying actual or potential problems using assessments skills and interviewing techniques
- Validating existing info
- Preparing the client both physically and emotionally for surgery
- Education of the client and family/significant others relating to assuming self care, or of the provision of ongoing care for clients requiring extended observation and interventions
8
Q
Psychosocial assessment
A
Situational changes
- Support- family, spiritually, significant others
- Impact on lifestyle
Concerns with the unknown
- Effect of daily living
- Depth of anxiety and fear
- Concerns with body image
- Past experiences
- Knowledge deficit
- Identify the amount and type of preoperative info the person needs to know
9
Q
Fight or flight response- stress response
A
- Protective mechanisms that we experience when threatened, when facing harm, when stressed
- Changes occur in the body to help the person deal with the situation effectively- hormones released
Increases awareness
(HR elevated, RR elevates,BP increases) - This is helpful but if sustained becomes damaging to the body, can result in problems that threaten recovery
- Delay wound healing
- Increase CVS or Respiratory issues
10
Q
Physiological factors that place the older adult at risk of surgery
A
- Neurological - sensory losses, decreased reaction (nurse needs to orientate the patient, observe for signs of pain)
- Pulmonary system- reduce diaphragm, rub case stiffeners , decreased lung volume
- CVS0 degeneration in myocardium- changes in cardiac reserve
- Renal system- reduce flow to kidneys- strict FBC, increased urine frequency, call bell to assist
- Metabolic- lower metabolic rate, change in water volume- risk of electrolyte imbalance
- Skin- decreases subcutaneous tissue- high risk of pressure injury
11
Q
Preparing the patient- Informed consent
A
- Patient provided with relevant info to enable them to make a choice- informed
- The patient must be deemed mentally competent
- Understand the language and not be affected by medication or drugs when the info is provided
- The consent must be given voluntarily without coercion or manipulation
- The patient must understand the implications of consenting to something
- Consent should include disclosure of risks
12
Q
Preoperative client education- nurse acts as a coach
A
- Give a rationale for pre and post operative procedure, the client is better prepared to participate on care
- Explanation and demonstration of post-operative exercise
- Diaphgramatic breathing
- Incentive spirometry
- Positive expiratory pressure therapy coughing
- Turning
- Leg exercise
13
Q
Physical preparation
A
- Maintenance of fluid and electrolyte balance
- NBM 4 hours prior
- 2 hours of liquids up to 200mls
- Reduction of surgical risk of infection (Hair removal if causing interference)
- Bowel (induce loose and frequent stools)
- Rest is essential for normal hearing
14
Q
Transfer to the ward with comprehensive orders
A
- Vital signs
- Pain control
- Rate and type of intravenous fluid
- Urine and gastrointestinal output
- Other medications
- Laboratory investigations
15
Q
Postoperative care- nursing management is directed at preventing complications so that the clients return to the highest level of functioning people
A
- Focused body systems- to detect complications
- The principle causes of postoperative complications are a surgical wound, the effects of prolonged immobility during surgery and recovery/rehabilitation and the influence of anesthesia and analgesics
- Virtually any body system can be affected. The nurse must consider the interrelationship of all systems and therapies involved
16
Q
Postoperative complications
A
- Failure in having the patient actively involved in recovery adds to the risk of complications
- Neurological and physiological
- Repsiraoty
- Cardiovascular
- Gastrointestinal
- Genitourinary system
- Musculoskeletal
- Integumentary system
17
Q
ABCDEFG assessments Look, Listen and Feel
A
- Use your eyes, ears and hands to look, listen and palpate as you follow the algorithm to assess and manage your patient
- It helps to have a logical approach to deal with each situation
- You are aiming to detect physiological abnormalities and possibly putting history, signs and tests together to make a diagnosis
- Physical assessment= critical thinking
- It involves looking at your patent, their observations and their clinical notes and history
18
Q
Circulation - Neurovascular observations
A
- To evaluate sensory and motor function (neural) and peripheral circulation- trauma, unrelieved pressure and ischemia can cause permanent damage to muscles, nerves and vessels
- Observations include pulses, capillary refill, skin colour and temp, sensation and motor function
- Assessment findings of the affected extremity must be compared to those of the unaffected extremity
- Assessment should be proximal and distal to the site of injury or surgery if not precluded by a device such as a cast or splint
- Even subtle changes must be recognised as important and differences must be communicated to the physical promptly
19
Q
Consider and Document other facts
A
Health and holistic ADL’s Mobility Risk assessment Mouth care Patient education Family conversations including any end of life discussions Medical review attended Investigations/procedures attended Referrals Discharge planning
20
Q
Nursing considerations
A
- Maintain respiratory function
- Maintain circulation function
- Promoting elimination and adequate nutrition
- Promoting urinary elimination
- Promoting wound healing
- Achieving rest and comfort
- Managing /enhancing self concept
21
Q
Client expectations and discharge
A
- Evaluate their expectations early in the postoperative stage
- Pain relief
- Effectiveness of intervention
- Have the clients needs been met?
- Discharge plans are in place
- Care of wound site and dressings
- Actions and side effect of medications
- Activities allowed or prohibited
- Activities can be resumed safely
- Dietary Restrictions
- Where and when to follow up care
- Answers to any individual questions or concerns
