Perioperative Flashcards
refers to partial or complete restoration of a damaged
organ or body part
Restorative (reconstructive)
Categories according to urgency/timing
Unplanned (emergency, imperative/urgent)
Planned (planned required surgery, elective, optional)
Scope of preop
Informed consent Nursing activities are directed towards patient support, teaching and preparation for the procedure
repair congenitally defective structure
constructive
(1) sit on edge of bed or lie supine with knees flexed to relax abdominal muscle; (2) place hand on abdomen; (3) inhale through nose until abdomen balloons outwards; (4) exhale thru pursed lips while contracting abdominal muscles
deep breathing
kheirurgos means
working by hand
looking into/to visualize
Oscopy
preoperative teaching includes the following
- Assess learning needs of the patients, consider expectations, level of
understanding, age and cultural background
o Discussion about diet and family visits
o Review of OR procedures
o Preparing patient for recovery (importance of ROM exercises postoperatively,
breathing and coughing exercises, etc.)
o Discussion on pain control
performed to estimate the extent of disease and confirm the diagnosis of a particular patient.
exploratory
the longer the duration of the disease, the lower the resistance of the patient, the higher the risk of surgery
Duration of the disease
SURGERY
Activities on the day of surgery
o Early morning care
o Pre- operative medication
o Recording
o Transportation to OR
o Care of patient’s family
The nurse’s report will serve as a concise evaluation of the care given during the entire pre-operative phase.
The nurse’s report will communicate all pertinent data to the OR nurse.
Contains records of pre- operative teaching content and the patient’s (as well as patient’s family) responses; vital sign, pre- operative medications given, laboratory and diagnostic results
recording
performed to remove diseased, damage, or congenitally malformed body
organ/ part.
curative/ablative
Begins when the patient is transferred to PACU or Recovery Room onwards
POST- OPERATIVE PHASE
fears of patient
o fear of destruction of body image
o fear of permanent disability
o fear of pain
o fear of dying
Generally, patients indicated for surgery should have light dinner,
should take nothing per orem, post-midnight, have an enema (as
ordered)
Bowel Preparation
MAJOR CATEGORIES OF SURGICAL PROCEDURES ARE ACC. TO WHAT
According to purpose
According to urgency/timing
According to extent/magnitude
Patients will to live, cooperation
mental outlook
increases risk for complications (hypokalemia, hyponatremia, dehydration)
Fluid and Electrolyte balances
Emergency category within 30mins-1 hr
Category A
cause of erosion
Continuous physical irritation
Infection
Inflammation/ ulceration
determine the patient’s ability to sustain expenses needed for the surgery, medication, etc.
occupational status
turning and reposition every 2 hours; turning team
Turning exercises
done to identify and correct problems to decrease patient’s risk of
complications during and after surgery.
It is also performed to obtain baseline data for post-operative comparison
Assessment
(1) on sitting or lying position, lace fingers and hold them tightly across incision before coughing [small pillow or folded towel over incision site may do]; (2) seconds then cough deep from the lungs once or twice; (3) encourage patient to perform DBE before coughing.
Coughing
Scope of Intraop
Nursing activities focus on patient safety, facilitation of the procedure, prevention of infection and satisfactory physiologic response to anesthesia and surgery
creation of temporary or permanent opening
Ostomy
activities performed by the professional nurse during the pre-, intra- and post-operative
phases of the patient’s surgical experience.
PERIOPERATIVE NURSING PRACTICE
performed for patients’ wellbeing.
Elective
Begins when the patient is transferred to the OR table and ends upon admission to the post
anesthesia care unit.
INTRA- OPERATIVE PHASE
COMMON SUFFIXES DESCRIBING SURGICAL PROCEDURES
Ectomy
Orrhaphy
Ostomy
Otomy
Plasty
Oscopy
Lysis
Involves high risk for patients
Prolonged period of time in OR table
Large amount of blood may be lost
Higher risk of post- operative complications
Major surgery
performed to help the physician in determining the cause of the symptom experience of a particular patient (i.e. biopsy)
diagnostic
Extensive surgeries (i.e. amputation, heart transplant, kidney transplant) may require changes in the patient’s lifestyle.
lifestyle change
Some increase vulnerability to bleeding while some increase vulnerability to
infection
use of drugs
removal of an organ/ gland
ectomy
In contrast to physiologic preparation, physical preparation refers to interventions that would directly prepare a patient for surgery.
physical preparation
Emergency category within 1-2 hrs
Category B
Activities to do on the eve of surgery
o Skin Preparation
o Bowel Preparation
o Preparing for anesthesia
o Promoting rest and sleep
Period of postop
Commonly ends outside the facility where surgery is performed
Beginning of Postoperative
Patient is transferred
to recovery unit
Shave the area to be operated (area of preparation should always be wider and longer than proposed incision)
Use adequate lighting and sterile razor.
Shave against or in the direction of hair growth
Check potential sites for infection
skin preparation
may start as early as in the ER and may be continued until the patient is transported to the OR (holding room)
emergency situations
used to remove tissue that does not contain cancerous cells, but may develop into a malignant tumor.
preventive
Factor that
o They generally have increased sensitivity to stress, effects of anesthesia and other drugs.
o Often dehydrate/malnourished
o Frequently have other degenerative disorders
o More prone to fluid and electrolyte imbalance
Age
FACTORS AFFECTING THE DEGREE OF SURGICAL RISK OF PATIENTS
Physical and mental condition
Extent of disease
Extent of surgical procedure
Caliber of the professional staff
Rupture of an organ, artery or bleb (blister)
Perforation
repair or reconstruction
Plasty
Branch of medicine concerned with the treatment of diseases, injury and deformity by operation or manipulation
SURGERY
Categories according to extent/magnitude
Minor
Major
Activities/care in preoperative phase
Assessment
Pre-operative Teaching
Psychological Preparation
Physiological Preparation
Physical Preparation
Spiritual Preparation
Securing appropriate documents for legal purposes
performed not to cure a patient from a disease but to alleviate signs and symptoms
palliative
collective term for many physiologic factors that cause neurochemical change
stress response
Beginning of Intraoperative
Patient is transferred to
OR bed
cutting into a tissue
Otomy
adequacy of staff, training, equipment; highly competent staff.
Caliber of the professional staff
Present little risk to life
Generally not prolonged
No-vital organs involved
Leads to few serious complication
Uses local anesthesia
Minor surgery
Surgery came from the Greek word
kheirurgos
Ending of Preoperative
Patient is transferred to
OR bed
Common causes of obstruction:
Vasoconstriction
Tumor
Foreign bodies
Asphyxia
Period of preop
Period used for patient’s physical and psychological preparation for surgery
What to teach in Pre-operative Teachings:
DBCE
Turning exercises
Extremity exercises
Ambulation
MAJOR EFFECTS OF SURGERY
stress response
Disruption of vascular system
Lowered defense against infection
Disruption of organ function
Body image disturbance
Lifestyle change
Reinforce surgeon’s teachings
Identify anxieties of the patient’s
Listen to patient’s verbalization of fear
Psychological Preparation
Factors under physical and mental condition
age
nutritional status
fluid and electrolyte balance
general history of patient
use of drugs
occupational status
mental outlook
preoperative teaching: involves explanations of procedures, patient care activities and physical feelings that the patient may encounter during the perioperative experience.
Information
Ending of Intraoperative
Patient is transferred to
PACU/post surgery unit
Teaching Children for OR
Use simple languages, supplement with pictures, books and films
Show pictures of doctors and nurses in surgical dress
May use puppet show
Allow patient to have a hands-on play with the surgical instruments (with close
supervision)
flex and extend each joint while lying
Extremity exercises
refers to the organ or body parts that is involved
Location
Father of surgery
Hippocrates
Preparing the parent spiritually could give rise to several issue hence, it is vital to seek the preference of the parents regarding this matter.
Spiritual Preparation
sample of major surgery
exploratory lapaotomy
PATHOLOGIC CONDITIONS REQUIRING SURGERY
PERFORATION
OBSTRUCTION/Blockage
EROSION
Tumor
what to assess in Pre- operative Assessment:
Allergies
Medication and substances
Herbs and nutritional supplements use
Cultural and religious preferences
Functional assessment
Level of anxiety
Medical history
categories according to purpose
Diagnostic
Exploratory
Curative/Ablative
Palliative
Restorative(reconstructive)
Preventive
Cosmetic improvement
Ablative
Constructive
factors under extent of disease
nature of the disease
location
duration of the disease
As soon as the patient is set for operation, the patient will be experiencing constant stress at varying levels
o differs among individuals and the type of surgery performed, general health status and other factors.
o Stress levels could be addressed by allaying the anxiety of the patient, meeting the patient’s needs constantly and helping the patient reestablish optimum functioning after the surgery.
stress response
The branch of medicine dealing with manual and operative procedures for correction of
deformities and defects, repair of injuries and diagnosis and cure of certain diseases.
SURGERY
Scope of postop
Nursing activities including positioning, monitoring, addressing psychological body image disturbances
In caring for a patient for surgery, the nurse should also consider the patient’s family.
The nurse is to provide information on how to assist the patient in going about the procedure as well as how they could assist the patient in going about the procedure as well as how they could assist the patient in his/ her recovery.
Care of patient’s family
Impairment of the flow of vital body fluids (tubes, arteries, ventricles, sinuses, ducts)
obstruction/blockage
Before administering any premedication, the nurse must ascertain that the consent form has been completed, signed and placed in the chart.
Pre-operative medications are given at least 45 minutes before the induction of anesthesia however, pre-medication may be omitted altogether depending on the anesthesiologist’s preference.
Pre- operative medication
samples of minor surgery
appendectomy, breast mass excision, suturing
abnormal growth of tissue that form mass without physiological function within the body which may either be benign or malignant.
tumor
Beginning of Preoperative
Surgical decision is made
(1) alternate dorsiflexion and plantar flexion of feet; (2) flex, extend the knees and press back of knees into bed while dorsiflexing the feet; (3) raise and lower legs alternately from the surface of the bed
extremity exercise
Some of the medications that are given pre-operatively are:
Anticholinergics (scopolamine, atrophine sulfate)
Antianxiety (diazepam, midazolam)
H2 Receptor antagonist ( cimetidine, ranitidine)
Narcotics ( meperidine, morphine)
Sedatives ( Pentobarbital, sodium)
Tranquilizer ( promethaxine, HCL)
repair or suture of a body part (
orrhaphy
Wearing off of a surface of membrane or surface of a tissue
erosion
When an operation involves the manipulation of a certain organ in a body, this may lead to the disruption of organs function
due to anesthesia, manipulation of organs
Disruption of organ function
removal of eye
enuclation
related to the severity of the disease
Nature of the disease
preoperative teaching: nurse assists the patient in identifying effective coping mechanisms in dealing with anxiety and fear; provision of emotional support
Psychosocial support
Ending of Postoperative
Resolution of surgical
sequela
When transporting a patient to the OR, the nurse should:
Check the identity of the patient
Verify surgical procedure, site and surgeon (if the patient is
heavily sedated, the surgeon may be asked to identify the
patient)
Check IV infusion, indwelling catheters and other gadgets
attached to the patient
Check for consent
Accomplish the OR checklist
Transportation to OR
must be performed within 24-48 hours
Imperative/ urgent
requested by patient, not necessary for health, for aesthetics
Optional
necessary for the patient’s wellbeing but not urgent.
Planned Required Surgery
to loosen, separate, breakdown
Lysis
A side from disruption of the vascular system as a reason for lowered biologic defense,
the impairment of the integrity of the skin could also contribute to this condition.
Lowered defense against infection
Begins when the decision for surgery is made and ends when the patient is transferred to the
operating room bed.
PRE-OPERATIVE PHASE
1) turn to sides; (2) sit up on bed and dangle feet; (3) transfer to bedside chair; (4) walk around bed then corridor
Ambulation
performed immediately, stat surgery
save life, save function, remove damaged organ
Emergency (unplanned surgery)
Involves a thorough physical assessment to identify whether or not the patient is capable of enduring the surgery
May involve diagnostic procedures such as ECG, chest x-ray, spirometry and other tests (cardio pulmonary clearance)
physiologic preparation
Involves bathing the patient, helping the patient change into hospital gown or OR gown and other bedside care
Early morning care
promotes faster clearance of inhaled anesthesia’s, done 5-10 times every hour;
teach patient how to splint surgical incision
DBCE-
preoperative teaching: involves guiding the patient in practicing the patient in the postoperative period. Doing this may decrease anxiety, hasten patient’s recovery and prevent the occurrence of complications
skill training
The anesthesiologist visit’s the patient for appropriate assessment
The anesthesiologist may ask about previous experiences that necessitated the use of anesthetic agents, assess for the cardiac reserve, explain to the patient the nature of anesthesia
Preparing for anesthesia
three levels of preoperative teaching
information
psychosocial support
skill training
strengthening weakened area, rejoin disconnected area, correct deformity
Restorative (reconstructive)
performed to remove diseased program
ablative
medications are given for any of the following purposes:
Decrease amount of anesthesia needed.
Decrease secretion of saliva gastric juices
To prevent nausea and vomiting
Decrease anxiety and provide sedation
Some surgical procedures may involve removal of some body parts (amputation) or incision in areas of the body that are exposed (face, legs, neck) which may lead to the development of self-esteem issues
Body image disturbance
a process of action embracing perception, thought, feelings and
performance.
Instruction of teachings is best given during this phase of the perioperative procedure.
It helps patients in coping with psychological stress of surgery.
The nurse teaches patient how to participate in their own postoperative recovery.
preoperative teaching
o Blood vessels are ligated and served which disturbs the vascular system hence bleeding occurs.
o In this event, hemostasis must be done to prevent excessive blood loss.
Disruption of vascular system
o Blood vessels are ligated
performed for aesthetic purposes.
Cosmetic improvement
needed to promote wound healing and recovery
nutrition
Generally assessed to help the physician determine whether or not the patient is capable of enduring the surgical procedure.
general history of patient
Period of intraop
Period when the patient is monitored , sedated, prepped, draped and operated
PHASES OF SURGERY
Pre- operative
Intra- operative
Post- operative
