Pre-Operative Flashcards
Types of Surgery
1) Elective
2) Urgent
3) Emergent
Surgery planned for correction of a non-acute problem. It is planned in advance.
Ex: Cataract removal, Total Joint Replacement
Hernia repair, Hemmorrhoidectomy
Elective
Requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hours.
Ex: Intestinal Obstruction, Bladder Obstruction, Kidney or Ureteral Stones, Bone Fracture, Eye Injury, Acute Cholecystitis
Urgent
Requires immediate intervention because of life threatening consequences.
Ex: Gunshot/Stab Wound, Severe Bleeding, Abdominal Aortic Aneurysm, Compound Fracture, Appendectomy
Emergent
Removal of (Excision)
ectomy
ex: Tonsilectomy
Surgical repair of (Suturing of)
orrhaphy
ex: Herniaorrhaphy
Creation of an opening (Surgical Opening)
ostomy
ex: Colostomy
Process of cutting into
otomy
ex: Lobotomy
Reconstructive ( Surgical Repair of)
plasty
ex: Rhinoplasty
Direct visual examination using some type of scope.
scopy
ex: Colposcopy
Reasons for Surgery:
1) Diagnostic
2) Curative
3) Restorative
4) Palliative
5) Cosmetic
Performed to detemine the origin and cause of a problem:
Diagnostic
ex: Breast Biopsy, Exploratory Laparotomy, Arthroscopy
Performed to solve a health problem by repairing or removing the cause:
Curative
ex: Cholcystectomy, Appendectomy, Hysterectomy
Performed to improve a patient’s functional ability:
Restorative
ex: Total Knee Repacement, Finger Reimplantation
Performed to relieve symptoms of a disease process, but does not cure:
Palliative
ex: Colostomy, Nerve Root Resection, Tumor Debulking, Ilestomy
Performed primarily to alter or repair personal appearance:
Cosmetic
ex: Liposuction, Revision of Scars, Rhinoplasty
Explains what the physician will be doing:
Detailed Consent
PAT
Pre-Admission Testing; performed from 24 hours to 28 days before the scheduled surgery.
Most Common PAT’s:
1) Urinalysis (protein, glucose, blood & bacteria)
2) Blood Type & Screen
3) CBC or H&H (Complete Blood Count)
(Hemoglobin Level & Hematocrit)
4) Clotting Studies:
- PT: Prothrombin Time
- INR: International Normalized Ratio
- aPTT: Activated Partial Thromboplastin Time
- Platelet Count
5) Electrolyte Levels
6) Serum Creatinine & Blood Urea Nitrogen levels
7) Pregnancy Test (depending on age & nature of procedure)
NSAID’s in relation to Surgery:
Blood thinners stopped 1-2 weeks prior to surgery.
The Physical Assessment:
1) Provides baseline health status
2) Review pre-operative labs/diagnostic studies
3) First assess part of body to be operated on
4) Extent of examination will depend on setting
Reason for Cognitive/Neuro Status Review:
1) Specify what patient is oriented to: time, place, etc
2) Adverse reactions to anesthesia
3) Any Neuro or Cognitive history (co-morbidities) such as: AMS, Dementia, Alzheimers, Seizures, Unsteady Gait, Parkinsons
4) Ability to follow directions
Reason for Cardiovascular Review:
1) Past Cardiac History including: HTN, MI, Arrythmias, Heart Failure
2) Cardiac Diseases result in 30% more deaths related to administration of anesthesia
3) Decreased tissue perfusion impeding wound healing
Smoking in relation to Surgeries:
Cessation of smoking should occur 3-4 weeks prior to surgery
Adipose Tissue Complications:
Less vascular, complication on infection and poor wound healing. Affects overall recovery.
Ways to monitor renal function:
- BUN (dehydration)
- Creatinine (renal disease)
- Urinalysis
- Monitoring I & O
Ways to monitor Hepatic function:
- Albumin
- Fibrinogen
- Immunoglobulin Levels
- Liver Disease (Alcoholism, Hepatitis, Substance Abuse)
Most common pre-existing endocrine patho:
Diabetes
Ways to monitor Endocrine Status:
- Hemoglobin A1C (provides a 3 month hx)
- Accucheck (at the moment only)
Risks of Alcohol/Drug or Nicotine use related to surgery:
- Potential problem with anesthesia, analgesia, and withdrawal complications (Delirium, tremming, withdrawal within 72 hours)
- Tobacco or inhaled drugs reduces hemoglobin levels (presenting more of a problem with anesthesia)
Given to everyone undergoing a procedure. Provides reason for procedure, options, risks and who will be performing procedure.
Informed Consent
Nurse in relation to informed consent:
Nurse is a witness of voluntary signature.
Who can give consent to pt:
Physician only
What does a pre-operative checklist consist of:
- Assess part of the body that will be operated
- Baseline head to toe assessment (mental/physical)
- Review pt’s health hx: past medical, past surgical, adverse reactions
- Review pre-op labs/diagnostic studies:
(Chest X-rays, EKG) and Bloodwork:
CBC, CBC w/diff (done up to 4 weeks prior)
PT, PTT, Cross Match - Report any unusual findings
What are some Pre-operative nursing diagnoses?
- Anxiety
- Knowledge Deficit
- Fear
- Acute Pain
TPN
Total parenteral nutrition
NPO related to surgery
Usually NPO after midnight, could be anywhere from 4-8 hours before surgery
Interventions related to pre-operative patient:
- Client Education: deep breathing, cough, relaxation, turning, moving, antiembolism stockings, leg exercises, pain control, drains/tubes
- Nutrition/Fluids: NPO, Meds
- Intestinal Prep: NPO, NGT Insertion, Enema
- Preop Skin Prep: allergies (iodine,tape), soap & water, antimicrobials, avoid shaving
- Rest/Sleep: important for procedure
- Pre-anesthetic meds
- Pre-op checklist
- Transportation to Surgical Suite
PCD
Pneumatic Compression Devices
Types of drains/tubes:
- Foley Catheter
- Hemovac
- Jackson Pratt
Why is a GI Prep done?
- Reduces risk of vomiting
- Reduces Aspiration (leads to pneumonia)
- Better visualization
- Prevents Contamination (fecal matter)
When is NGT Inserted?
Nasogastric tube insertion occurs after abdomial or GI surgery.
Helps with gas accumulation.
Shaving related to surgery:
Should be avoided, clippers should be used instead. Because it is an entry point for microbes, results in poor wound healing and infection.
Should be done 48 hours before surgery.
Analgesics
- Morphine
- Codeine
- Dilautid
- Phentinol
Anticholinergics:
Reduce pharyngeal & gastric secretions.
- Atropine
- Robinul
H2 receptor antagonist:
- Zofran: vomiting, nausea (post-op)
When are meds administered preoperatively?
- PO Meds: 60-90 min before
- IM/SQ: 30-60 min before
- IV: 15-20 min before or in the holding area
