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Med-Surg/Adult Health > Pre-Op > Flashcards

Pre-Op Flashcards

1
Q

Peri-op

A

Pre/Intra/post

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2
Q

Why surgery

A

Diagnosis, cure, palliative (alleviate sx) , prevention, cosmetic (cut in face), exploration.

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3
Q

Ambulatory setting

A

Same day outpatient…popping up everywhere, regional anesthetics versus general, in and out same day, pts recover at home versus hospital, cost is less.

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4
Q

Elective surgery

A

Knee replacement

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5
Q

Emergency

A

From trauma or need comes up abruptly

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6
Q

Nurse needs to know what?

A

Risks, co-morbidities, why are they having surgery, identify pts response to stress, be aware of post-op risks, positioning.

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7
Q

Nursing Process is

A

ESSENTIAL

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8
Q

Assessment Priority

A
  • *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)
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9
Q

If nurse identifies risks, what to do??

A

Notify surgical team!

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10
Q

Subjective Data pre-op includes

A

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!”)

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11
Q

What happens to body in stress??

A

Tachycardia and htn.

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12
Q

What other things impact body during surgery?

A

Age, past experience with surgery and hospitalization, current health, socioeconomic status.

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13
Q

Health Hx

A

Previous surgeries, medical hx, previous hospitalizations, issues, drug reactions, wounds, women (cycle and OB and current), family HX!!

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14
Q

Shock!

A

End of day- bp PLUMMETS and death. Anesthesia causes vasodilation- dropping BP, **ask if they are taking htn meds

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15
Q

Diabetes patients are a risk

A

Insulin intake… they lower BG and surgery is a stressor but before surgery they are NPO

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16
Q

Aspirin has an effect on

A

Bleeding….

17
Q

Long-term anticoagulation therapy risk

A

procedure = taking off anticoagulant…but then stroke? what to do. Doctor decides this decision but nurse has to identify the problem

18
Q

Herbal Meds and Substance use

A

Marijauan, opioid, all herbals….nonjudgmental and matter of fact. Alcohol poises risk to liver and malnourishment and seizing during surgery.

19
Q

Latex food

A

Banana/avocado/egg/potato/peach

20
Q

Cardiovascular

A

-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??

21
Q

Cardiologist Needed

A

Anticipate 12 lead ECG, anyone with cardio disease is @ risk for VTE (venous thromboembolism).

22
Q

Neurology

A
  • Cognitive Ability to sign consent?
  • Hearing! (aids?)
  • Hx of stroke?
  • Spinal cord injury
  • multiplesclorosis
23
Q

Renal Insufficiency

A
  • @ 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??
24
Q

Prego

A

All women should have a test prior

25
Q

Hepatic Function

A
  • Monitor ALT/AST and bili
  • Check coagulation and platelets (ptINR)
  • Ask about hepatitis and obesity and
  • Glucose/homeostasis
  • Ask about alcohol use!!
  • JAUNDICED
26
Q

Integumentary

A

-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

27
Q

Skeletal

A
  • Neck issues
  • Assistive device to ambulate?
  • special positioning
28
Q

Endocrine

A 
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.
29
Q

Thyroid

A
  • Metabolism
  • hypo vs hyper…slows down or speeds up
  • TSH
30
Q

Immune

A
  • Immunosuppressants = @ risk for slower wound healing.
  • Corticosteroids… give during or taper before.
  • WATCH Temperature and WBCs.
  • HIV/Sickle Cell…
31
Q

Fluids

A

low- bp low

Someone who is vomiting…electrolytes are low but would need supplements before going into surgery.

32
Q

NPO status

A

Impacts pre-op. If they weren’t eating well and then they’re NPO, @ risk for electrolyte deficiency…

33
Q

Nutritional status

A

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)

34
Q

LABS

A 
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)
35
Q

Teaching pre-op?

A

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)

Med-Surg/Adult Health (16 decks)

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