Pre/Intra/Post Operative Care Flashcards
Categories of Surgery
▫️Emergency (Aortic dissection repair- prolonged, often uncontrolled high BP)
▫️Urgent (<48hrs, ectopic pregnancy)
▫️Required (Pace-Maker insertion)
▫️Elective (planned, ex: hysterectomy, knee/hip arthroplasty)
▫️optional (mammoplasty)
Types of Surgery
- Diagnostic
- Curative/repair
- Palliative
- Preventative
- Explorative
- Cosmetic
A type of Surgery to determine the presence or extent of a pathological abnormality (scope, biopsy)
Diagnostic
A type of Surgery, for elimination of pathological condition (removal of appendix) or repair of anatomy (fractured femur)
▫️Curative/Repair
A type of Surgery, is for alleviation of symptoms at end of life without curing (to remove/alleviate obstructions caused by tumours; airway- esophageal stent, obstructed bowels -ostomy)
Palliative
A type of Surgery, for the removal of pre-malignant (pre-cancerous) tissues.
Preventative
A Surgical examination to determine the nature/extent of disease (Laparotomy)
▫️Explorative
A type of Surgery for breast re-construction, skin grafting following severe burns
Cosmetic
The basic information for nurses in the surgical setting:
▫️know the nature of the disorder necessitating surgery and any coexisting disease processes
▫️identify the individual patient’s response to the stress of surgery
▫️assess the results of appropriate preoperative diagnostic tests
▫️consider the bodily alterations and potential risks and complications associated with the surgical procedure
Pre-op assessment
▫️review lab and diagnostic studies
▫️review patients health history
▫️assess physical, psychological and culture needs
Legal prep for surgery. All required forms are signed and in chart.
▫️informed consent ▫️blood transfusions ▫️advance directives ▫️power of attorney ▫️DNR
Who is responsible for obtaining consent before surgery?
▫️Surgeon
It’s a Neuromuscular blocking agent:
-pt. will definitely be intubated bcoz the drug suppresses nervous system functioning.
▫️rocuronium “roc”
Spinal anaesthesia
Injection of agent into CSF of ____, usually below ____.
Autonomic, sensory and motor blockade
subarachnoid space
L2
Epidural block
Injection of agent into epidural space
does not enter _____
Sensory pathway blocked, but ____ fibers intact.
CHF
motor
Do sensation test with epidural block using___
Also do movement test____
cold/ice pack
can move extremely, but shouldn’t be able to feel
In Spinal and Epidural anaesthesia, observe closely for signs of too much ANS block:
▫️bradycardia
▫️hypotension
▫️nausea and vomiting
In the Spinal anaesthesia recovery?
▫️pt. not to move ▫️flat on back, no pillow x 8-12hrs ▫️maintain body alignment ▫️report c/o headache to nurse ▫️notify charge nurse or physician of wet dressing ▫️frequent B/P checks
Criteria for discharge from PACU (phase 1)
▫️oriented 3x ▫️VS stable (priority assessment: ABCs) ▫️no excess bleeding ▫️pain, nausea and vomiting under control ▫️O2 saturation ▫️no respiratory distress ▫️urine output
Initial assessment in post operative care (Phase 2)
▫️VS ▫️airway, breathing, circulation (ABC) ▫️rate and quality of respiration ▫️auscultate breath sounds in all fields ▫️assess surgical site
Nrsng Mngmt for Cardiovascular complications:
Frequent monitoring of VS
🔺Notify physician if:
▫️BP gradually decreases (worry of bleed somewhere)
▫️irregular cardiac rhythm develops
▫️significant variation from preoperative readings
▫️systolic <90 mmHg or >160mmHg
▫️pulse <60 or >120 bpm
🔺assess skin colour, temperature, and moisture
__________ is the most significant general nursing measure to prevent postoperative complications
Early ambulation
Urine output for first 24hrs expected postoperatively
800-1500mls
discharge criteria day surgery
▫️all PACU discharge criteria have been met
▫️No IV narcotics for the last 30 mins
▫️minimal nausea and vomiting
▫️voided
▫️no excess bleeding or drainage
▫️O2 sats. >90% / no respiratory depression
▫️able to ambulate (age, surgery, disability appropriate)
▫️eaten (toast, plain cookie if not nauseated)
▫️responsible person to pick them up
▫️discharge instructions given and understood
▫️follow up visit with Surgeon or family doctor
