POSTOP&PREOP Flashcards by Sean Digrazia

Planned for correction of a non-acute problem

Cataract removal, hernia repair, hemorrhoidectomy

Elective Surgery

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Immediate intervention to prevent life-threatening consequences (Gun shot,stab, severe bleeding, abdominal aortic aneurysm, compound fracture, appendectomy)

Emergency Surgery

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To relieve symptoms of a disease process, but does not cure (colostomy, nerve root resection, tumor debulking, ileostomy)

Palliative surgery

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Performed to determine the origin and cause of a disorder or the cell types for cancer

Diagnostic Surgery

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Performed To improve patient’s functional ability (total knee replacement,finger reimplantation)

Restorative Surgery

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Perform to resolve a health problem by repairing or removing the cause
(Laparoscopic, cholecystectomy, mastectomy, hysterectomy)

Curative Surgery

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Primarily to alter or enhance personal appearance (liposuction, revision of scars, rhinoplasty blepharoplasty)

Cosmetic Surgery

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Requires prompt intervention may be life-threatening if is delayed more than 24 to 48 hours (intestinal obstruction, bladder obstruction,or ureteral stones, bone fracture,eye injury, acute cholecystitis)

Urgent Surgery

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Procedure without significant risk; often done with local anesthesia ( incision & drainage, implantation of a venous access device, muscle biopsy)

Minor Surgery

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Procedure of greater risk usually

Major surgery

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2 degrees of risks for surgery

Minor & Major

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What is an autologous blood transfusion?

Pts blood is withdrawn at the blood bank several weeks before surgery
Prepared & stored to be re administered during the surgery

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Epoetin Alfa may be given before surgery to stimulate RBC production & hemostatic agents may be given before & during surgery to promote clotting

How bloodless surgery is performed.

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What types of patients are at higher risk for surgical complications?

Infants & older pts above 75

- Pts on steroids

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Why should a pt that is taking herbal supplements discontinue them 2-3 weeks prior to surgery

Many herbal supplements interact with anesthetic agents or interfere with blood clotting.
-if going w/ out supplements is impossible, the herbal supplement container should be brought to anesthesiologist

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Surgical Risk factors for pt w/ diabetes mellitus

May cause swings in blood glucose levels that are difficult to control even for a pt w/ out diabetes.

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Surgical risk factors for pts w advanced age w/ inactivity

Healing is slower in older adults
Risk of disuse syndrome
Hypostatic pneumonia
Thrombus formation is higher in inactive older adults

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Surgical risk factors for very Young age

Infants have difficulty with temperature control and in maintaining normal circulatory blood volume they are at risk of dehydration.

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Surgical Risk factors for patients with malnutrition

Inadequate nutritional stored leads to infection, poor wound healing, and skin breakdown

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Surgical risk factors for pt w/ dehydration

Reduced circulation volume reduces kidney perfusion, which predisposed the pt to a reduced iron output & thrombus formation.
Dehydration also alters electrolyte values
A dehydrated patient is more at risk for problems with pressure areas during surgery

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Surgical risk factors for pts w/ obesity

Extremely heavy patient does not breathe as deeply and is at risk of hypostatic pneumonia.
excessive fatty tissue also is a factor in poor wound healing

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surgical Risk factors for patient with cardiovascular problems

Pts w/ hypertension, left ventricular hypertrophy, cardiac dysrhythmias or a hx of congestive heart failure are at a higher risk for myocardial infarction from the high stress of surgery and anesthesia.

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Surgical risk factors for patient with peripheral vascular disease

Poor circulation in the extremities predisposed the pt to possible thrombus formation & pressure sores on the lower legs & feet.
Embolism stocking or devices are prescribe for use during & after surgery

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Surgical risk factors for patient with substance abuse

May alter reaction to anesthetic agents.

-alcohol dependence may cause w/drawl symptoms if the use of alcohol is discontinued abruptly

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Surgical risk factors for patient that smokes

- Causes increased lung secretions from anesthesia and predisposes the patient to atelectasis & pneumonia post operatively. - smokers are more prone to thrombus formation

Surgical risk factors for patient on anti-coagulant

Makes patient more prone to excessive bleeding

Measures to prevent surgical site infection

-cleanse the wound with special -cleanser (antibacterial)

Removal or destruction of

Lysis | Ex- Neurolysis ( freeing nerve from adhesion )

Tumor

Oma | Ex- excision of fibroma ( removal of a connective tissue tumor)

Cutting out or off

Ectomy | Ex- colectomy ( cutting out a part of the colon )

To furnish with an outlet

Ostomy | Ex - colostomy ( creating an outlet for the colon from the body)

Cutting into

Otomy | Ex- thoracotomy (cutting into the chest cavity)

Revision,molding, or repair of tissue

Plasty | Ex- mammoplasty ( revision of the breast)

Fixation, anchoring in place

Pexy | Ex- orchiopexy ( fixation of undescended testicle in the scrotum)

General topics of pre op teaching

- teach correct breathing - correct coughing - correct turning - teach leg exercises ( high priority )

Perioperative nursing

Refers to care before during & after surgery.

Why must the pt be NPO prior to surgery? How long should they be NPO?

- To prevent nausea, vomiting & aspiration | - 8 hours NPO

What are some of the common medication that the patient may be allowed to take prior to surgery?

- BP meds - Thyroid meds - anticonvulsant - Heart med

Important considerations for skin prep prior to surgery

- Night b4 surgery pt should take shower w/ special antibacterial cleanser or just soap & water to remove as many microorganisms as possible - remove hair from operative site - nail polish removed - makeup is removed - Jewelry & oral piercings removed

Why is temp kept at 66-70 degrees in the OR at all times?

To discourage microbial growth and to keep the surgical team comfortable under the bright lights, & in layers of surgical clothing.

Major functions of scrub tech or nurse?

- Gathers all equipment for the procedure - prepare sterile supplies - gown & gloves surgeons - Assist with sterile draping of the pt

Major functions of circulating nurse

- Coordinates care - Verifies that the consent is signed & accurate & that surgical site is correctly marked - setting up operating room - gathers supplies

Induced by the administration of an inhalant gas or medication introduced intravenously

General anesthesia

Extensive surgery for which it is desirable for patient to be unconscious with relax muscles ( well controlled with assisted ventilation; few effects)

Inhalation anesthesia

Shorter surgery rapid induction ( little post op nausea or vomiting )

Intravenous anesthesia

Accomplished by administering a nerve block more economical than general, injecting in spinal epidural Caudal or peripheral nerve

Regional anesthesia

Surgery in lower half of body (pt can be conscious; does not require fasting; no nausea or vomiting after)

Spinal anesthesia

For gynecologic procedures & childbirth | no diet restrictions post operatively

Epidural anesthesia

Foot surgery & some orthopedic surgeries ( pt is conscious; can cooperate with instructions)

Nerve block anesthesia

Minor surgical procedures ( can produce good pain control; pt may remain conscious)

Local anesthesia

Surgery of short duration for which unconsciousness is undesirable, may be used in combination with local or spinal, ( rapid reversal, pt is away but can breathe w/ out life assistance; little to no nausea/vomiting, amnesia or surgery)

Procedural/ conscious sedation

Surgery for pt who are unable to have general anesthesia

Hypnosis

Surgery for pt who cannot tolerate other anesthesia, such as in life-threatening trauma ( provides decrease in pain )

Cryothermia

What are 3 stages of anesthesia ?

- induction - maintenance - emergence

Induction ( stage of anesthesia )

Unconsciousness is induced

Maintenance (stages of anesthesia)

Period during which the surgical procedure is performed.

Emergence ( stages of anesthesia )

Surgery is completed & the pt is prepared to return to consciousness; neuromuscular blocking agents are reversed.

What pt measurement is needed for the appropriate dosage of anesthetic?

Weight & height

Who’s responsible for obtaining an informed consent ?

Surgeon

What info is including on the surgical consent?

- procedure explained - risks & benefits - pt must be mentally competent - Full name & DOB - surgical procedure - no abbreviations on the consent, - pt signature & witness

Who is responsible for answering the pts questions regarding the procedure?

Surgeon

Who cannot give their own surgical consent?

Someone not capable of giving consent & a relative cannot be reached

What is the nurses responsibility regarding the surgical consent?

Check the consent form has been signed before giving the preop medication

Patient can sign an “X” for their name if unable to sign there own signature? True or false ?

True

Who is able to give consent for emergency surgery when the pt cannot give consent ?

- Next of kin | - Power of attorney

What happens if no family can be found & the patient cannot give their own consent in an emergency?

The surgery can continue | Two surgeons have to agree to have the surgery done

Before surgery begins, while all members of the team are present a time out occurs during which a final verification of the correct pt, procedure, site, & implants ( if applicable). Any ?’s or concerns must be resolved before the procedure begins

Time out

What are the priority things that the patient should be taught during the pre-operative period?

Teaching the pt the correct breathing, coughing, turning & leg exercises is a high priority

Important things to remember when teaching the elderly pt

- observe signs of toxicity because liver & kidney function decreases. - Will give a decreased dose of narcotics & sedatives - Teach them the use of the inspirometer - breathing exercises - To prevent falls informed them to use the call bell - slow position changes - Handouts

Purpose for administering preoperative medications?

- Reduce anxiety & promote a restful state - Decrease secretion of mucus & other body fluids - counteract nausea & reduce emesis - enhance the effects of the anesthetic.

What are the room preparations for the pt returning from surgery to the floor?

- make bed with fresh linens - raise the bed to height of the stretcher - Place an IV pole - Gather an emesis or bags - chucks pad - vitals

Type of surgery that uses special light beams instead of instead of instruments for surgical procedures.

Laser surgery

Miniaturization of medical instruments is a key trend encouraging the use of small and efficient optical fibers

Fiber optic surgery

Allows doctors to perform many types of complex procedures with more precision, flexibility & control than is possible with conventional techniques

Robotic surgery

What happens if telephone permission is needed for the surgical consent ?

- Call power of attorney or next of kin | - 2 nurses get 2 signatures over the phone from power of attorney or next of kin

What needs to be done if the patients name is misspelled on the surgical consent?

Get a new consent form with the correct information

Purpose of the blood consent

Gives consent to give blood products

Process for surgical site identification

- Surgeon puts their initials on the surgical site | - they follow the universal protocol to check the correct surgical site markings are checked

What is done with their dentures before surgery ?

Give them to the family members or put them in the pts belongings

What is the purpose for administering preoperative meds?

- Reduce anxiety & promote a restful state - Decrease secretion of mucus and other body fluids - counteract nausea & reduce emesis - enhance the effects of the anesthetic