pre-op pt. Flashcards
Pain
Common after surgery
When should we do Patient Education?
We want to do patient education?
What role does teamwork and collaboration have on care of the peri-operative pt.?
Must acknowledge that their is going to be more than one person working with the patient within the OR and outside of the OR
How does fluid & electrolytes relate to the surgical pt.?
If the pt. hemorrhages out on the table it can cause a decrease in the pt.’s circulating BV. A decrease in the pt.’s circulating BV can cause a decrease in BP and an increase in HR. If pt has a decrease in BP then that decrease in BP will cause improper perfusion to the kidneys. Kidneys need proper perfusion to work properly. This will cause electrolyte retention due to low urine output.
How does immunity & infectioon relate to the surgical pt.?
Infection of the surgical site in the number one post op. complication in patients.
How does mobility relate to the surgical pt.?
Mobility can affect the way a pt. is positioned while in the OR. It can also affect the pt.’s recovery because they need to be able to ambulate after surgery to avoid post op. complications
How does stress & coping relate to the surgical pt.?
Some pt.’s are nervous about undergoing surgery due to the unknown; it’s our jobs as nurses to help them cope with this stress and anxiety
How does tissue intergrity relate to the the surgical pt.?
Post op. pt. will have a surgical site wound; different things can affect the way a pt.’s wound healing process
How does tissue perfusion relate to the surgical pt.?
Impaired tissue perfusion can cause things like hypoxia, hypoxemia, or even a DVT
Preoperative
Before the pt. goes into surgery; we’re preparing for them to go into surgery
Intraoperative
The patient is in surgery
Postoperative
After the patients surgery; pt. is in the PACU
Diagnostic surgery
used to determine the cause and orgin of a disorder; have to take a tissue sample via biopsy with the intention of diagnosing…sometimes we have to stage it
Curative surgery
removing a diseased area and repairing/eliminating the pathological condition; ex. removing a benign tumor, removing a diseased gallbladder (Cholestasis) or appendicitis
Palliative surgery
Doing a surgery to improve the quality of ones life without a cure; surgery should not be extensive; ex. forming illeostomy for someone who has a tumor in the intestines or cutting a nerve so someone doesn’t feel pain in a certain area
Preventive surgery
Having a surgery to prevent a illness/condition from occurring; ex. getting a double mastectomy if you were positive for the BRCA 1 or BRCA 2 gene or removing a pre-cancerous mole
Reconstructive surgery
performed on an abnormal or damaged body structure to improve its functional ability; ex. total knee replacement or total hip replacement
Cosmetic surgery
performed to reshape normal body structures to improve the pt. appearance or self-image
Transplant surgery
performed to replace a malfunctioning structure
Elective surgery
Is pre-planned, done to correct a condition that is non-life threatening; ex. total knee replacement, cataract surgery, ex.
Urgent surgery
Surgery that needs to be done within 24-48 hrs. before it become life threatening; ex. kidney stones, urethral blockage, bowel obstruction, fracture, eye injury
Emergency surgery
Surgery that needs to be done right away because it is life threatening; ex, GSW, stabbing, abdominal bleed, compound fracture, appendectomy
How does age affect surgery?
pt.’s developmental status will affect the way they cope with surgery bot physically and psychologically; physiological and pshycological reactions to surgery along with anesthesia can affect/bring out the pt.’s stress response
How does surgery affect our infants?
parents can help prepare our infants by adjusting care that will support the needs of the child; provide oral means for the infant for any pre-surgery prodecures; help parents get through grief, guilt, or anxiety; monitor their RS, F+E, and glucose
How does surgery affect our children ?
Assess their developmental status so we an do use proper teaching techniques along with communication with them; assess stress and coping; assess safety and comfort post op.
How does surgery affect out geriatric population?
assess any pre-existing conditions ex. HTN, diabetes, COPD, cardiac arrhythmias, CHF; assess ability to hear to ensure proper education and communication; more prone to hypothermia due to loss of subq fat; more prone to PNA, infection and other complications; more prone to respiratory and cardiac mortality+morbidities due to aged lungs and heart
Can we do surgery on a patient with infection?
No; unless it was an emergency
Can we do surgery on pt.’s with chronic illnesses or pre-existing conditions?
We would need a write off from their provider stating that the pt. is stable enough for surgery
Pre-admission
Ensure we have: pre-op teaching done, pre-op meds in the pt., pre-op assessment done, pre-op admission testing done,
What is an advance directive?
Written instructions of what the pt. wants done to them during end of life care if they’re ever in terminal illness or mental incapacity; AD do not apply when the pt. goes into surgery
Corticosteroids
reduce inflammation; delay wound healing, causes to thin out
Anticoagulants
slow down blood clotting; increase the pt.’s risk of hemorrhaging in the OR or post op bleeding; ex. ibuprofen, aspirin, heparin, warfarin, enoxaparin, neproxin
Diuretics
remove excess fluid from the body; where water goes sodium follows along with other electrolytes; this loss of electrolytes will cause them to be low and could cause cardiac problems in the OR or cause us not to be able to operate
Sedative/Tranquilizers
If combined with post op. meds. pt. can have an adverse reaction
Herbs & Supplements
Some herb and supplements can cause an increase in bleeding such as: vitamin E, garlic, fish oil, and ginko; all herbs & supplements must be stopped 2-3 wks prior to surgery
Physical Assessment: Nutrition
must know H&W because this lets anesthesia know how much anesthesia to administer to pt.; nutrients needed for wound healing should be increased prior to surgery (protein); obese and malnourished pt.’s are at a higher risk for complications
Physical Assessment: Respiratory
assessing history of chronic respiratory problems such as: COPD, asthma, CHF (left sisded symptoms are in the lungs and sound wet); assessing smoking…can affect the pt.’s recovery post op and intra op.; assessing current status…if pt. has a active upper respiratory infection we cannot operate on them
Physical Assessment: Cardiovascular
history of CV disease puts pt. at risk for complications intra op. and/or post op.
Physical Assessment: Hepatic & Renal
needed to effectively remove waste products; hepatic disorders affect metabolism of anesthesia & meds; renal disorders affect excretion of anesthesia, meds, & fluid
Physical Assessment: Endocrine
pt. with diabetes are at increased risk for hypo/hyperglycemia, wound infection and metabolic acidosis; pt.’s receiving steroids (play on the adrenals) are at risk for adrenal insufficiency (improper creation of hormones); pt with hyper/hypothyroidism can affect metabolic rate; important that anesthesia knows about these chronic disorders
Physical Assessment: Immunological
assess for allergies, sensitivities, or reactions; pt.’s with immunological disorders are at increased risk for infection; pt.’s who are immunosuppressed: chemo pts., HIV pts., pts. taking immunosuppressants after surgery, and pts on corticosteroids
Physical Assessment: Neurological
assess ability to respond, follow commands, and keep train of thought; assess vision and hearing; assess cognitive functioning; establish pre-op baseline so that we can compare post op.
Physical Assessment: Integumentary
assess current condition of skin especially for rashes, breakdown, or dermalogical conditions; select body parts free from body art for injections, IV sites, & labs
Physical Assessment: Mobility
assess for mobility problems, may affect the way a pt. is positioned during surgery; mobility aids should be brought with pt. the same day of surgery
Prior Medication Therapy: Corticosteroids
can cause CV collapse if discontinued suddenly; Dr. has to prescribe a tapering schedule
Prior Medication Therapy: Thiazide diuretics
Can cause extreme respiratory depression due to an imbalance of
