perioperative Flashcards
what is surgery?
treatment through operation and instrumentation
purposes of surgery
diagnose
explore
cure
transplant
palliative
reconstructing
preventative
cosmetic
-ectomy
incision or removal
-lysis
the destruction of
-orrhaphy
the repair or suture of
-oscopy
looking into
-ostsomy
creation of an opening
-otomy
the cutting into or incision of
-plasty
the repair or reconstruction of
MIS
minimally invasive surgery
- laparoscopy
robotic-assisted surgery
Da Vinci robot
emergent vs elective surgery
emergency surgery and planned surgery
inpatient vs outpatient
inpatient is admitted after surgery
outpatient go home same day
three phases of surgery
peri-op
intra-op
post-op
readiness for surgery (6 main things to monitor)
VS
especially BP
hemostasis and coagulation
fluid and electrolytes
infection- resolved before hand preferable
nutrition - to promote healing
purpose of pre-op assessment
to prepare pt for surgery and protect from complications
pre-op health history
medical
surgical
family
- esp with anesth.
- malignant hyperthermia
malignant hyperthermia
life-threatening response to coming off anesthesia
psychosocial pre-op assessment
- fear and anxiety
- stressors
- knowledge and reason for surgery
which substances are in the pre-op medication assessment
- anticoagulants
- antiplatelets
- opioids
- antihypertensives
- herbs and supplements (Ginko, fish oil, cava, ginger and valerian
drug intolerance vs allergy
drug intol. is unpleasant reactions of medicine
allergy is anaphylaxis, hives
pre-op allergy assessment
- sulfa drugs
- latex
-* history of latex exposure, hay fever, asthma, or allergy to eggs, avocadoes, bananas, chestnuts, and peaches
cardiovascular pre-op ROS
- CV hx?
- 12 leads ECG, coagulation labs
endocrine pre-op ROS
- diabetes
- thyroid disorders (altered metabolism of drugs)
- addisons disease (may need corticoid steroids)
hepatic pre-op ROS
- if liver is affected, clotting factors may be low causing bleeding
- drug metabolism
respiratory pre-op ROS
- dx/ conditions?
- tobacco use?
- ABGs, PFTs
GU/renal pre-op ROS
- drug metabolism/ excretion
- BUN/CR (very important)
- if voiding issues-> may need cath.
neurological pre-op ROS
- need to know baseline for nl
- emergence delirium: difficulty coming in and out of anesth. (elderly are more prone)
musculoskeletal pre-op ROS
- be aware of surgical positioning
- spinal anesthesia, slow to wear off
- know if mobility aids are used
pre-op labs
- VS
- BMI/ BSA
- type and cross
- CBC (for anemia/ infection)
- BMP (for electrol./ kidney funct)
- coagulation (PT, INR, PTT)
- serum albumin
- BG
physical pre-op ROS
?
nutritional pre-op ROS
- caffeine may be needed after waking up
- anesthesia hangs on to overweight ppl longer
RNs role in consent
witness for the MD
pre-op diagnostic tests
- ECG
- HCG (preg.)
- urinalysis (UTI)
- CXR (enlarged heart or lung issues)
- the sooner they go home….
the more instructions they will need
three requirements for informed consent
- adequate disclosure
- clear understanding
- voluntary consent
who is responsible for consent
MD
post op coughing
have pt take deep breaths and cough
splint any incisions
one of the best ways to have good surgical outcomes …
early ambulation
traditional NPO
NPO after midnight the day before surgery
American Society of anesthesiologist recommendations for fasting
clear liquids- 2 hrs
breast milk- 2 hrs
other milk/formula- 4 hrs
light meal- 8 hrs
regular meal- 8 hrs
pre-op, remove…
cosmetics
nail polish
jewelry
dentures
glasses or contacts
getting dressed pre-op…
put on gown
remove undergarments
cover hair
when to empty bladder pre op
before pre-op meds
typical pre-op meds
cefazolin- infection
atropine glycopyrrolate- ↓ oral secre.
scopolamine- ↓N/V
insulin- stabalize BG
metoclopramide- ↑ gastric emptying
ondansetron- ↓N/V
diazepam- ↑anx., induce sedation
labetalol- manage htn
famotidine- ↓ HCl secre. ↑pH, ↓gastric volume
opioids- relieve pain
make sure pt has IV access when?
before surgery
what to mark on the patient before surgery
site of operation
TJC goals for surgery 2025
- correct surgery on correct pt in correct body part
- mark correct place where surgery is to be done
- pause before the surgery to make sure a mistake isnt being made
