Perioperative Care Flashcards
What are some purposes for surgery?
- Diagnostic: determine the presence and extent of a pathological condition.
- Curative: eliminate or repair a pathologic condition – taking care of the problem directly.
- Palliative: alleviate symptoms/maximize comfort without cure.
- Prevention: reduce the risk of developing some type of issue/disease.
- Exploratory: the extent of an issue/disease is unknown. determine the nature or extent of a disease. with the use of advanced diagnostic tests (MRI, ultrasound, etc.), exploration is less common because we can identify many problems noninvasively.
- Transplant: removing an organ and replacing it with the same organ (from a donor)
- Cosmetic/Reconstructive: cosmetic surgeries (breast augmentation, etc.). bodily trauma/deformities that could use reconstructive surgery (cleft palate on babies, etc.)
What are the types of Urgencies for surgery?
- Elective surgery: Not a necessary or time sensitive surgery (ex: palliative surgery, etc.)
- Urgent surgery: The patient needs to have the surgery soon (within 24-48 hours).
- Emergency surgery: The patient needs the surgery right now, immediately, it cannot wait. (ex: aortic aneurysm - patients could die within minutes)
Major vs. Minor Surgery
Major Surgery: Massive surgery (ex: open heart surgery)
Minor Surgery: Minimal invasiveness and extent of surgery (ex: mole removal)
Two types of surgical settings:
- Same-day surgery/outpatient surgery/ambulatory surgery: patient goes home the same day of their surgery. may be in hospital or outpatient surgery clinics. (ex: wisdom teeth removal)
- Inpatient surgery: patient is admitted to hospital after surgery for recovery. Important term: POD # = Post-Op Day (ex: POD 4 = patient had their surgery 4 days ago)
Pre-operative Nursing Assessment: What fears may patients have about surgery?
- Fear about fatality, whether they will live through the surgery.
- Fear about body alterations, how they will look (scars, amputation)
- Fear about how much the surgery will cost.
- Fear about the result of the surgery impacting their daily life after/change their abilities (being able to walk/run after, throat surgery impacting their voice)
- Fear about the doctor performing the surgery incorrectly
- Fear of pain
- Fear that the drugs during surgery won’t work (anesthesia)
Pre-op Nursing Assessment: Previous Surgical Experiences - What information do you gather?
- What was pt.s previous surgical experience like - if applicable?
Did they have complications, and if so, what were they? Did they have difficult to manage pain post op? Did they experience other post op issues like nausea and vomiting? How did they react to anesthesia?
Pre-Op Nursing Assessment: What health history factors do we need to assess and why?
We need to assess a patient’s health history to see if they have any surgical risk factors (factors that will put them at risk for surgical complications)
Factors we assess:
- Smoking: increases the risk of atelectasis (collapse of alveoli) & pneumonia
- Age: infants & older adults have a higher risk of complications
- Poor nutrition: leads to poor wound healing
- Obesity: decreased ventilation capacity; increased risk of atelectasis, pneumonia, blood clots, slower healing. wound separation, & other complications
- Immunocompromised: body is more vulnerable to infection (ex: pt.’s undergone radiation, chemotherapy, immunosuppressive agents, and steroids)
- Pregnancy: must consider mother & child’s needs. Surgery only considered on urgent/emergency basis
Pre-Op Nursing Assessment: What medications do we need to note and why?
- Note all current medications: think about medications effect within surgical experience & potential complications
- Warfarin (coumadin): anticoagulant medication, pt. is at an increased risk for bleeding.
- Oxycodone: pt. might have a tolerance built up to pain meds, may need more post-op
- Insulin: insulin or oral hypoglycemic drugs may need adjustments during the periopertive period because of increased body metabolism, decreased oral intake, stress, and anesthesia
- Certain medications may be withheld before surgery (timeframe will vary). Make sure to verify with the pt. that the medication is stopped.
Pre-Op Nursing Assessment: What is a true drug allergy? What do we do if pt. is allergic to med? Do we never give med to pt. who is allergic?
Always need to assess the pt. for allergies.
- True drug allergy: produces hives and/or an anaphylactic reaction, causing cardiopulmonary compromise (e.g., hypotension, tachycardia, bronchospasm)
- If our patient has a true drug allergy: place an allergy band on the patient, document their drug allergy in the chart and what their reaction is
- If a patient has a drug allergy, there are some cases when we can still give that medication to the patient. (ex: patient with allergy to contrast dye has a heart attack and needs to go to the cath lab and get contrast dye to save their life - there is no second option to contrast dye, they must undergo this procedure; safety measures like epipen/benadryl would be provided. most of the time if the reaction to a drug is anaphylactic shock, we do not give it). we are always measuring the benefits vs. the risk when it comes to allergies
Pre-op Nursing Assessments: Why do we perform a baseline assessment?
- We do a baseline assessment pre-operatively so we can compare the patient during and after surgery, to see if there are any important changes. (ex: pt. comes back from surgery with left-side drooping, and they are still unconscious from surgery. if there are no indications in their chart that this was present before surgery, stroke protocol could be initiated mistakenly). Also helps prepare us for potential post-operative issues.
Pre-op Nursing Assessment: What is one diagnostic test/screening we always do pre-op?
- Assess for any ordered diagnostic testing/screening. One test we always do: get a blood type on our patient and get a crossmatch on them. This is important because every patient during surgery is at a high risk for bleeding, so we need to know their blood type in the event of a blood transfusion. Also, pregnancy tests on female patients.
Pre-op Nursing Assessment: Why do we assess cultural/religious factors?
- We assess these factors to prepare for any accommodations/advocacy needed for patient (ex: allowing a patient to keep on a hijab during surgery even though it is against usual surgical protocol) (ex: Jehovah’s witnesses do not believe in receiving blood transfusions – but they can donate their own blood and transfuse their own blood)
Pre-op Nursing Assessment: Why is it important to know who is with the patient?
- This is usually the person we need to contact, let them know what the progress is, emergency contact, and the person we contact post-surgery and bring to the patient
Pre-op Nursing Assessment: Why do we assess for patient belongings?
- The pt. cannot keep track of their belongings post-op, therefore we need to keep a good record of their belongings/make sure the person with the pt. takes their belongings, so that they are not lost.
Pre-op Nursing Assessment: Why do we need to know when the last time the pt. ate/drank (NPO status)?
- This is important because with surgery, if the pt. ate or drink it puts them at risk for aspiration (aspiration is when anything that’s not air goes into the lungs). Usually, cannot eat or drink about 12 hours before surgery. If pt. aspirates, puts them at risk for pneumonia and other infections. Eating/drinking also puts them at risk for nausea and vomiting post-surgery; vomiting can also make them aspirate post-surgically because the pt. is sleepy and cannot prevent breathing in their own vomit. ALWAYS check NPO status and if it is not available, ask.
