Pre/intra-op Flashcards
Risk factors for surgery
- fever
- obesity
- age
- alcohol abuse
- smoking
- diabetes
Expected diagnostics before surgery
- complete blood count
- EKG
- coagulation study
- blood type/cross panel
- electrolyte panel
Teaching before surgery
- how you’ll be assessing pain
- there will be pain meds
- expected outcomes
After surgery teaching
- leg exercises
- IS
Surcigal care improvement project
- infection prevention
- DVT prevention
- prevention of serious cardiac events
Skin preparation
- do not shave patients prior to surgery
- use clippers
- chloraprep baths
Intestinal preparation
- only clear GI if needing surgery
- patient will be on NPO status before surgery
- meds may be given PO if the risk is higher not to give them(Physician decides this)
Palliative surgery
Relieves symptoms(usually pain) but does not change the course of events(disease/death) -comfort
Cosmetic surgery
performed primarily to alter or enhance physical appearance
Elective surgery
-planned for the correction of a non-acute surgery(patient chooses to have this done)
Emergent surgery
-requires immediate intervention because of life threatening consequences
Urgent surgery
Requires prompt intervention, may be life threatening if delayed more than 24-48 hours
Simple surgery(extent)
Small amount of tissue removed
Radical surgery(extent)
Extensive surgery beyond the area involved
Minor surgery(degree of risk)
- Procedure without significant risk
- minimal blood loss
- low length of surgery
- low length of anesthesia
- minimal complication
Major surgery(degree of risk)
- increases in blood loss
- potential for lots of complications
- longer surgeries
Ectomy
Removal of
Oscopy
To look into
Otomy
To make an incision
Ostomy
To make an opening with drainage
Plasty
Molding or shaping through a special procedure
Pre-op check list
- identify Patient
- proper name band
- check allergies(Diprivan is linked to egg allergies)
- skin preparation
- start IV
- remove finger nail polish
- pt. needs to void before surgery
Pre-op medications
- antibiotic(give within one hour of first incision)
- midazolam(verses) Antianxiety
- atropine:decreases secretions
- ranitidine(Zantac) acid blocker
Informed consent
- consent is good for 30 days
- nurses serve as witness that patient signed consent(surgeon does the informing)
Advance directive
- does patient have a representative
- pt. made wishes known?
- in Michigan age for concent is 18 unless an emancipated minor
Site specific marking
Surgeon, and Patient agree on site and sign it
Minimally invasive surgery
- surgery that uses an endoscope
- can use insufflation for a better view
Advantages of minimally invasive surgery
Less blood loss,faster recovery time
Disadvantages of minimally invasive surgery
Expensive, surgeon needs extra training, insufflation can cause CO2 bubble that causes shoulder pain(walking and movement is best to treat that)
Robotic surgery
A form of minimally invasive surgery
- very expensive equipment
- lengthier procedure
General anesthesia
- causes sedation/loss of consciousness
- potential for hypotension and arrhythmias
- can be IV push or inhalation(ETT,LMA)
- ETT allows an airway(sensitive oral care)
Level 1 anesthesia
- analgesia and sedation(relaxation)
- patient feels drowsy and ends with loss of consciousness
Level 2 anesthesia
- excitation and involuntary muscle movement
- may have irregular breathing patterns
Level 3 anesthesia
- depression of vitals
- sensations to pain are lost
- CRNA does intubation
- level we want for surgery
Level 4 anesthesia
- danger/toxicity level
- very low depression or vital functions
- respiratory failure,cardiac arrest
Malignant hyperthermia
- genetic response:reactions interferes with calcium in muscles, muscles contract
- treat with dantrolene sodium(skeletal muscle relaxant via IV)
- monitor for tachycardia and increase CO2, and fever
- discontinue surgery safely
Regional anesthesia
Loss of sensation and movement of a body part
-patient remains conscious but often times can be sedated
Spinal
-needle goes through duramatter into CSF
-epidural
Injected into epidural space
Reactions to both spinal and epidural
- if drug rises too high can cause respiratory depression(lay patient down)
- spinal headaches d/t loss of CSF
- change in BP
- urinary retention
Nerve block
Local anesthetic inserted around the area
Moderate sedation(conscious sedation)
- state of reduced consciousness
- patient can protect airway and follow basic commands
- meds have amnesia effect
- considered safer
- cannot drive for 24 hours
Positioning
- OR nurse helps in positioning the patient
- beware of skin integrity
- patients who receive anesthesia are more flexible
Supine(dorsal recumbent)
- most common position
- when patient gets anesthesia(best trachial access)
Lithotomy position
Lying on back legs up in air
Trendelenburg
On back, bed is tipped back
Safety concerns
- timeout before and after surgery
- grounding pad on pt. for electric shock(do not put near artificial metal body part)
- fire concerns
- supply count before and after
Maintain patients normal body temperature
- patients more prone to infection if get too cold and don’t warm up
- goal is to get pt. back to 36-38C within one hour after surgery
- bear hugger
- warm blanket on head
Sutures
May be absorbable or non-absorbable
Glue(dermabond)
may have steel strips as well
Retention sutures
Put in place when pt. is high risk for dehiscence(removed by surgeon)
Fibrin spray
Spray helps control bleeding during surgery
