Pre-Op Flashcards
Peri-op
Pre/Intra/post
Why surgery
Diagnosis, cure, palliative (alleviate sx) , prevention, cosmetic (cut in face), exploration.
Ambulatory setting
Same day outpatient…popping up everywhere, regional anesthetics versus general, in and out same day, pts recover at home versus hospital, cost is less.
Elective surgery
Knee replacement
Emergency
From trauma or need comes up abruptly
Nurse needs to know what?
Risks, co-morbidities, why are they having surgery, identify pts response to stress, be aware of post-op risks, positioning.
Nursing Process is
ESSENTIAL
Assessment Priority
- *Interview**
- TO identify risk in order to ensure safety.
- Provide info, clarify info, assess emotional status, allergy.
- Baseline vitals and values.
- identify surgical site!!
- all medical history
- review pre-op lab/dx testing
- Familial/cultural factors
- informed consent!! (includes adequate education and info)
If nurse identifies risks, what to do??
Notify surgical team!
Subjective Data pre-op includes
Psychosocial
Anxiety (to unknown)
Fear (religious, death, disability, informed consent, pain, discomfort, altered body image, scarring)
Hope (with no hope = anxiety…“you’ll be able to eat after, less pain!”)
What happens to body in stress??
Tachycardia and htn.
What other things impact body during surgery?
Age, past experience with surgery and hospitalization, current health, socioeconomic status.
Health Hx
Previous surgeries, medical hx, previous hospitalizations, issues, drug reactions, wounds, women (cycle and OB and current), family HX!!
Shock!
End of day- bp PLUMMETS and death. Anesthesia causes vasodilation- dropping BP, **ask if they are taking htn meds
Diabetes patients are a risk
Insulin intake… they lower BG and surgery is a stressor but before surgery they are NPO
Aspirin has an effect on
Bleeding….
Long-term anticoagulation therapy risk
procedure = taking off anticoagulant…but then stroke? what to do. Doctor decides this decision but nurse has to identify the problem
Herbal Meds and Substance use
Marijauan, opioid, all herbals….nonjudgmental and matter of fact. Alcohol poises risk to liver and malnourishment and seizing during surgery.
Latex food
Banana/avocado/egg/potato/peach
Cardiovascular
-Valve /dysrhythmia /CAD/htn/HF/nmi/ pacemaker/icd.
-Peripheral edema, pulses, bilateral bp.
-And if they have any of these, which treatment are they on? (meds)
-Labs?? coagulation studies?? @ risk for bleeding?
Lasix? @ risk for losing potassium…. check labs…check K…
-Dyspnea??
-Asthma?? Do they take daily inhalers? Well controlled? Triggers? How freq. suffer?
-COPD!! @ risk for post-op atelectasis
-Smoking? “stop smoking 6 months prior” Determine pack years.
-Sleep Apnea? CPAP?
-Obesity?
-Spinal or chest deformities?
-GI- when did they last eat/bowel movement/dentures…
-Pt. weight!
-Active bowel sounds??
Cardiologist Needed
Anticipate 12 lead ECG, anyone with cardio disease is @ risk for VTE (venous thromboembolism).
Neurology
- Cognitive Ability to sign consent?
- Hearing! (aids?)
- Hx of stroke?
- Spinal cord injury
- multiplesclorosis
Renal Insufficiency
- @ risk for not excreting well
- check ABGS… K and NA
- coagulation disorders due to low hgb
- @ risk for infection and wound healing
- BUN, Creat, GFR
- incontinent??
Prego
All women should have a test prior
Hepatic Function
- Monitor ALT/AST and bili
- Check coagulation and platelets (ptINR)
- Ask about hepatitis and obesity and
- Glucose/homeostasis
- Ask about alcohol use!!
- JAUNDICED
Integumentary
-Older pt…bony prominences? Cushions!
-Identify wounds, pressure spots, rashes, bruises, scars, skin color, temperature of skin, pallor??
-Cool/clammy? dec. perfusion = shock!
Want patient to be warm and dry
Skeletal
- Neck issues
- Assistive device to ambulate?
- special positioning
Endocrine
Diabetes...High risk for low and high blood sugar. Low bg-hypoglycemia, High bg-hyperglycemia. -delayed wound healing/infecton... KNOW proper amt of glucose Monitor levels during surgery -Hyperthyroidism. -Addison disease...need steroids.
Thyroid
- Metabolism
- hypo vs hyper…slows down or speeds up
- TSH
Immune
- Immunosuppressants = @ risk for slower wound healing.
- Corticosteroids… give during or taper before.
- WATCH Temperature and WBCs.
- HIV/Sickle Cell…
Fluids
low- bp low
Someone who is vomiting…electrolytes are low but would need supplements before going into surgery.
NPO status
Impacts pre-op. If they weren’t eating well and then they’re NPO, @ risk for electrolyte deficiency…
Nutritional status
Obesity…extra adipose tissue puts pressure on surgical site and holds on to anesthesia and @ risk for atelectasis.
Thin…look at albumin levels and supplement before or after surgery.
Coffee- withdrawal.
(nutritional status)
LABS
Respiratory - ABG, O2, chest Xray Diabetes - bg, bun, creat, GFR Kidney function Pulmonary function test CBC - Hgb (blood loss) ...hct...RBC...WBC (infection) ECG Electrolytes AST/ALT Bili Platelet count Serum Albumin (nutritional status)
Teaching pre-op?
Decreases stress/fear
Most SIG intervention we can do. Want them to feel prepared, not scared.
-Teach
Sensory (cold/…)
Process (
Procedure (IV/intubate /shaved/diet preop and postop)
Activities (spirometry and ambulation, turning/coughing)
Pain
Expectations after (cords/button/meds/pain rating scale)
NPO
- Informed CONSENT (disclosure, nature, risks, likelihood of oucome, alternatives, prognosis w/out surgery, voluntary)
- surgeon is responsible but we witness signature.
-Day of
(allergy band, site marked, HAND OFF COMM sbar)
