POSTOP&PREOP Flashcards
Planned for correction of a non-acute problem
Cataract removal, hernia repair, hemorrhoidectomy
Elective Surgery
Immediate intervention to prevent life-threatening consequences (Gun shot,stab, severe bleeding, abdominal aortic aneurysm, compound fracture, appendectomy)
Emergency Surgery
To relieve symptoms of a disease process, but does not cure (colostomy, nerve root resection, tumor debulking, ileostomy)
Palliative surgery
Performed to determine the origin and cause of a disorder or the cell types for cancer
Diagnostic Surgery
Performed To improve patient’s functional ability (total knee replacement,finger reimplantation)
Restorative Surgery
Perform to resolve a health problem by repairing or removing the cause
(Laparoscopic, cholecystectomy, mastectomy, hysterectomy)
Curative Surgery
Primarily to alter or enhance personal appearance (liposuction, revision of scars, rhinoplasty blepharoplasty)
Cosmetic Surgery
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
Procedure without significant risk; often done with local anesthesia ( incision & drainage, implantation of a venous access device, muscle biopsy)
Minor Surgery
Procedure of greater risk usually
Major surgery
2 degrees of risks for surgery
Minor & Major
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- Pts blood is withdrawn at the blood bank several weeks before surgery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
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.
What types of patients are at higher risk for surgical complications?
- Infants & older pts above 75
- Pts on steroids
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
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.
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
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.
Surgical Risk factors for patients with malnutrition
Inadequate nutritional stored leads to infection, poor wound healing, and skin breakdown
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
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
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.
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
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
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
