Perioperative Care Lecture Powerpoint Flashcards
Clean wounds
Uninfected operative wounds in which no inflammation is encountered and the wound is closed primarily, the respiratory, alimentary, genital, and urinary tracts do not qualify
Clean contaminated wound
Operative wounds in which a viscus is entered under controlled conditions and without unusual contamination
Contaminated wounds
Open, fresh, accidental wounds, operations with major breaks in sterile technique, or gross spillage from a viscus, wounds in which acute, nonpurulent inflammation was encountered as well
Dirty wounds
Old traumatic wounds with retained vitalized tissue, foreign bodies, or fecal contamination or wounds that involve existing clinical infection or perforated viscus
Nichols prep
Given a day before surgery, includes 4 components (polyethylene glycol, neomycin, azithromycin base, and metronidazole) to clean bowel before surgery
Operative techniques as infection prophylaxis after sedation but before operating (7)
- eliminate hair (trim don’t shave)
- effective skin prep and wait for it to dry (betadine or chlorohexadine)
- gentle tissue handling
- effective hemostasis
- eradicate dead space (possibility of becoming infected)
- operative time less than 2 hours
- closed suction drainage remote from incision
Postoperative fever
Low grade (100-101) fever that occurs after surgery, if develops 24 hrs after then atalectasis (try incentive spirometry), if next 48 hours then think UTI, if days 3-4 think wound infection, if day 5 DVT, and anything after that can be due to a drug fever
(wind, water, wound, walking, wonder drugs)
ASA classification of physical status in eval and prep for anesthesia and surgery
-ASA class 1 - no disturbance of any kind
-ASA class 2 - mild to moderate disturbance that may or may not be related to reason for surgery
-ASA class 3 - severe systemic disturbance that may or may not be related to reason for surgery, does limit activity
-ASA class 4 - severe systemic disturbance that is life threatening with or without surgery
-ASA class 5 - patient who has little chance at survival but is submitted to surgery as last resuscitative resort
-ASA class 6 - organ donation in declared brain dead patient
E - adding an E status to any of the above designates an emergency operation
High risk procedures (>5% cardiac complication rate) (2)
- emergency surgery
- prolonged surgeries with large fluid shift or blood loss
Medium risk procedures (1-5% cardiac complication rate) (3)
- neurosurgery
- abdominal or thoracic surgery
- minor vascular surgery
Low risk procedures (<1% cardiac complication rate) (3)
- breast surgery
- endoscopic procedures
- eye surgery
Example of a passive drain, example of an active drain
- Pentrose drain
- Jackson pratt drain (has grenade to squeeze for negative pressure to draw out material)
Acronym for post op orders formatting (ADCVAN DISMAL)
Admit/transfer orders Diagnosis Condition (critical, fair, good) Vitals (surgery specific, every hour, 15 min, etc) Activity Nursing care
Diet IV's (lactated ringers) Studies (X rays or such) Medications Allergies Labs
Pulmonary toilet
Encouragement of patients to take deep breaths, cough, and be elevated after surgery in order to increase clearing of secretions
Post op red flags (5)
- tachycardia
- hypotension
- tachypnea
- decreased urine output
- mental status changes
