Pre and Post Operative Care Flashcards

1
Q

What is a surgical procedure?

A

The treatment of injuries or disorders of the body by incision or manipulation, especially with instruments.
Involves cutting, abrading, suturing, or otherwise physically changing body tissues and organs.

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2
Q

List reasons for surgery

A
  • Biopsy
  • Staging of disease
  • Trauma
  • Removal of organ/ tumour/disease
  • Palliation of symptoms
  • Fracture
  • Transplant
  • Caesarean section
  • Reconstruction
  • Cosmetic
  • Organ/tissue repair
  • Sterilisation
  • Prophylactic
  • Screening for disease
  • Insertion/removal of medical devices
  • Wound debridement
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3
Q

What is pre-op care?

A

The preparation and management of a patient prior to surgery - Both physical and psychological preparation.

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4
Q

Why is pre-op care important?

A

Optimal physical and psychological preparation for surgery improves patient outcomes and may influence length of hospital stay and incidence of post-op complications.

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5
Q

What patient education can the nurse give to promote post-op recovery?

A
  • What to expect
  • What can help
  • Timings
  • Visiting hours/family support
  • Referral to other specialists; – OT/physio, Social work, Dietician, Psychologist, Prosthetics
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6
Q

Give 6 considerations the nurse should have when giving holistic pre-op care?

A
  • Elective versus emergency surgery
  • Reason for surgery/aims of surgery
  • Site of surgery and planned procedure
  • Nature of procedure
  • Post-operative issues and recovery period
  • Patient’s general condition including co-morbidity
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7
Q

What skin preparation will be needed pre op?

A
  • Pre-op bath/shower with soap day before or day of surgery unless contraindicated.
  • Marking of surgical site where appropriate.
  • Do not use hair removal routinely to reduce the risk of surgical site infection.
  • If hair has to be removed, use electric clippers with a single-use head on the day of surgery. Do not use razors for hair removal, because they increase the risk of surgical site infection.
  • Surgical skin prep immediately prior to incision (theatre side): povidone- iodine or chlorhexidine.
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8
Q

What bladder and bowel care is needed pre op?

A
  • Encourage voiding of urine prior to surgery.
  • Catheter may be required (lengthy surgery, lower abdominal incision, bladder surgery).
  • Routine bowel cleansing no longer advised.
  • Bowel prep may be needed in some cases to allow visualisation of bowel or facilitate ease of surgery.
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9
Q

What is the aim of fasting? What negatives are there?

A

The aim is to reduce the risk of pulmonary aspiration of gastric contents during the induction of general anaesthesia.

But we must also avoid adverse effects on patients and optimise the potential for speedy and safe recovery. Prolonged fasting has potential adverse effects including dehydration, electrolyte imbalances, glycaemic disturbances, anxiety and delayed wound healing.

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10
Q

What is the 2,6 rule?

A

‘2’ - Intake of water/clear fluid up to two hours before induction of anaesthesia.

‘6’ - A minimum preoperative fasting time of six hours for food (solids, milk and milk- containing drinks).

The anaesthetic team should consider further interventions for patients at higher risk of regurgitation and aspiration.

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11
Q

Discuss guidelines on resumption of fluids after surgery?

A

Adults and children should be allowed to resume drinking as soon as they wish after elective surgery. However, fluid intake should not be insisted upon before allowing discharge from a day or ambulatory surgery facility.

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12
Q

what happens with regular meds pre op?

A

Long term medication is considered at pre-assessment stage.
Decision to undertake surgery is balanced with the patient’s co- morbidity.
Abrupt withdrawal or omission of any regular medication during the fasting period can have potentially harmful effects.
Regular medication taken orally should be continued preoperatively unless there is advice to the contrary.
Up to 30 ml water may be given orally to help patients take their medication.

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13
Q

What is the aim of post-op care?

A

Overall aim is to prevent/reduce complications, promote healing and to return the patient to their previous state of health and/or maximise function

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14
Q

What 5 things should be assessed and monitored immediately post op?

A

o Evaluate and stabilise the patient.
o Maintain ABC.
o Monitor conscious levels, reflexes, vital signs, sensation, wounds.
o Equipment (VADs, drains, lines, catheters)
Anticipate potential problems

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15
Q

What nursing care is needed following recovery and transfer back to ward

A

-Patient observation;
NEWS, neurovascular status, skin/wound, drains/lines, pain, nausea/vomiting, fluid intake/output, bowels, resumption of diet, haemodynamic monitoring.

  • Prevention of complications.
  • Strict infection control measures.
  • Early mobilisation.
  • Follow up care/removal of clips, sutures, drains.
  • Rehabilitation/adaptation and psychological support.
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16
Q

What 4 key elements are needed to achieve early recovery for patients undergoing major surgery?

A
  • Pre-operative assessment, planning and preparation before admission.
  • Reducing the physical stress of the operation.
  • A structured approach to immediate post-operative and during (peri-operative) management, including pain relief.
  • Early mobilisation.
17
Q

What 15 things can minimise risk of complications?

A
  • Systematic and rigorous pre and post op monitoring.
  • Strict adherence to aseptic techniques.
  • Applying evidence based principles to surgical care.
  • Excellent verbal and written communication.
  • Treating patient holistically.
  • Pro-actively managing pain and other symptoms.
  • Optimal pre-op care
  • NEWS/wound assessment and care
  • Pharmacological intervention/pre-op prescribing
  • Assessment and recording of bladder/bowel function
  • Positioning and early mobilisation
  • Fluid and dietary support
  • Patient/family education
  • Post-discharge follow- up
  • Staff education
18
Q

Describe the 3 types of potential surgical site infections (contamination, colonisation, infection).

A

Contamination–presence of transient micro- organisms which does not impact on healing.

Colonisation– microbial organisms that grow and divide but do not cause harm or lead to infection.

Infection–microbial growth and invasion into host tissue leading to injury and interruption of wound healing.

19
Q

What intrinsic factors need considered in preventing infection?

A
  • Presence of foreign bodies in wound
  • Presence of necrotic tissue
  • Use of vasoconstricting drugs
  • Smoking behaviour
  • Immune system response
  • Genetic factors
  • Pre-existing conditions
  • Prior medical/surgical interventions
20
Q

What extrinsic factors need considered in preventing infection?

A
  • Pre-op showering/bathing using soap
  • Hair removal guidance
  • Pre-op nutritional status
  • Hand hygiene, masks, gloves, gowns, scrubs
  • Skin cleansing
  • Closure methods
  • Length and type of surgery
  • Wound care: cleansing, technique and dressing
  • Length of pre-op stay
21
Q

What is dehiscence?

A

Separation of the layers of a surgical wound.

22
Q

What can cause dehiscence?

A
  • Infection
  • Haematoma
  • Poor vascular supply; Smoking, Emboli, Anaemia
  • Malnutrition; Lack of protein, vitamins, minerals
  • Excessive exudate; Oedema/infection, intrinsic
  • Mechanical stress; Obesity, Oedema, Movement