Perioperative

Question 1

what are the 6 indications for surgery?

Answer 1

1) diagnosis : to determine the presence or extent of abnormality

2) cure: to eliminate or repair. pathological condition (ex: removing a ruptured appendix)

3) palliation : to alleviate symptoms without cure (cutting a nerve root to relieve pain)

4) prevention: to reduce the risk of developing a condition (removal of a mole before it becomes malignant)

5) cosmetic improvement: to alter physical appearance ( breast reconstruction post mastectomy)

6) exploration : to determine the nature or extent of disease (laparotomy)

Question 2

what does the suffix -ectomy mean?

Answer 2

excision/removal

Question 3

what does the suffix -oscopy mean?

Answer 3

looking into

Question 4

what does the suffix -ostomy mean?

Answer 4

creating of opening into

Question 5

what does the suffix -otomy mean?

Answer 5

cutting into/incision

Question 6

what does -plasty mean?

Answer 6

repair/reconstruction

Question 7

when does the pre-operative admission assessment occur and what is done?

Answer 7

usually occurs AT LEAST 1 day prior to surgery

youre checking their weight, physical assessment, consent forms, labs, airways etc.

Question 8

what are common day of surgery assessments that should be done?

Answer 8

psychosocial assessment: stress can negatively affect surgical outcomes and anxiety can impair cognition and decision making so best to help the pt through this

Question 9

what other assessments are done on the day of surgery?

Answer 9

health history
medications including herbal

Question 10

what is preopertive education and the 3 forms?

Answer 10

1) sensory - preoperative holding area may be noisy, drugs may be odorous, OR can be cold, light in the OR may be bright, monitoring machines may be heard (beeping)

2) procedural - what to bring and what type of clothing to wear, why turning, deep breathing and coughing after surgery is important (lowers risk of pneumonia and clears lungs), incentive spirometer, use pillow for splinting after surgery, mobilizing pain management

3) process information - a preoperative admission/holding area. family can stay here. when pt wakes up identify all monitors around them

Question 11

what are 7 common medications for preoperative pts?

Answer 11

1) benzodiazepines - reduces anxiety and used for sedative

2) anticholinergics - reduce respiratory and oral secretions

3) opioids - decrease intraoperative anesthetic requirements and pain

4) antiemetic - decrease nausea and vomiting after surgery

5) antacids - increase gastric pH, decreases gastric volume

6) antibiotics - routinely given IV 30min before surgery

7) eye drops - indicated for cataract surgery

Question 12

what is a circulating nurse?

Answer 12

not scrubbed, gloved or gowned
remains in the unsterile field

main responsibility is documentation and monitoring sterile field

pt safety as well

pt advocate and well being

Question 13

what is a scrub nurse?

Answer 13

performs surgical asepsis and remains in sterile field
gowned, gloved in sterile attire

main responsibility is assisting surgical team by preparing and handling instruments

Question 14

what is a registered nurse first assistant?

Answer 14

preoperative nurse with formal surgical education, skills and knowledge

main responsibility is to collaborate with surgeon on planning preoperative, intraoperative and postoperative patient care. they can also suture under the supervision of the surgeon

Question 15

what is the surgeon & assist?

Answer 15

performs surgical procedure
basically the big guy who is making the plans for surgery and does the surgery

the assist just holds the retractors and assists with hemostasis and suturing

Question 16

what is anesthesiologist?

Answer 16

responsible for administering anesthetic agents, monitoring vitals and adjusting meds as appropriate

Question 17

how does anesthesia work?

Answer 17

by blocking sensory nerve impulses thus patient will not feel pain

Question 18

what about positioning for surgery? 5 things

Answer 18

proper positioning involves:

1) ensure correct skeletal alignment

2) prevent pressure on nerves, skin, bony prominences

3) prevent occlusion of arteries and veins

4) provide modesty in exposure

5) recognize and respect individuals needs

Question 19

what is general anesthesia?

Answer 19

loss of consciousness, skeletal muscle relaxation

used for long surgeries

Question 20

what is local anesthesia?

Answer 20

loss of sensation without loss of consciousness

• injection of agent into the tissues through which the surgical incision will pass

Question 21

what is regional anesthesia?

Answer 21

reversible loss of sensation to a region of the body by blocking the nerve fibres

ex: epidural or spinal blockers

• injection of local anesthetic into or around a specific nerves or group of nerves

Question 22

what is procedural sedation?

Answer 22

midl depression of consciousness that result from administration of IV sedatives. this is so the patient can tolerate minor procedures but still maintain airway control

Question 23

where does spinal and epidural get injected?

Answer 23

spinal : local anesthetic given below L2
- Autonomic, sensory and motor blockade. vasodilation: may become hypotensive and no sensation of pain, no ability to move

epidural : injection of a local anesthetic into the epidural space. dosage can be titrated to control sensory or motor block

Question 24

which one is faster spinal or epidural?

Answer 24

spinal is faster but results are the same

Question 25

what signs are you looking for with spinal and epidural anesthesia?

Answer 25

signs of autonomic nerves system blockade
- hypotension, bradycardia, nausea and vomitting
- high blocks or excessive doses can lead to cardiac and respiratory depression

Question 26

what can spinal blocks cause?

Answer 26

leakage of spinal fluid
- headache is common side effect

Question 27

when does postoperative care begin?

Answer 27

immediately after surgery and continues until pt is completely healed

Question 28

what are the 3 phases of PACU? post anesthesia care unit?

Answer 28

phase I:
- focused on the patient basic life-sustaining needs
- constant vigilant monitoring

phase II:
- surgical patient is ambulatory

phase III:
ongoing care for patients who will be admitted to the unit and those who require observation or intervention

Question 29

what is the first sense to return to an unconscious patient?

Answer 29

hearing

so do neuro assessment

Question 30

what are some PACU alterations that could happen?

Answer 30

airway obstruction from patients tongue obstructing the pharynx

Question 31

what is emergency delirium?

Answer 31

disoriented, and exhibits bizarre behaviour. usually seen in peds and older patients

Question 32

what about delayed awakening?

Answer 32

prolonged drug action (opioids, sedatives)

Question 33

what are potentials alterations in temperature?

Answer 33

PACU: Hypothermia (T<35)
- burn victims
- surgical wounds

Clinical Unit: During the first 48hours
mild temperature (T<38): reflects surgical stress response

Elevated temperature (T>38): respiratory congestion or atelectasis

after 48 hours:
- elevated temperature (T >37.7) usually caused by infection

Question 34

Potential alterations in gastrointestinal function

Answer 34

PACU
- nausea and vomiting

Clinical unit
- slowed GI motility, delayed gastric emptying

Question 35

potential alterations in urinary function

Answer 35

expect about 30mL/hr