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Exam 3 > Pre-Operative Nursing > Flashcards

Pre-Operative Nursing Flashcards

1
Q

Peri-operative Nurse

A

Cares for client from the time the decision is made to have surgery to discharge from the hospital (pre-op, intra-op, post-op)

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2
Q

Emergent Surgery

A

Performed immediately to preserve the life of the client

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3
Q

Urgent Surgery

A

Necessary to be performed within 1-2 days

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4
Q

Elective Surgery

A

Scheduled and planned to provide preferred treatment

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5
Q

Diagnostic Surgery

A

Confirmation or establishment of a diagnoses

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6
Q

Exploratory Surgery

A

Surgical examination to determine the nature of extent of a disease

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7
Q

Ablative Surgery

A

To remove a diseased body part

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8
Q

Reconstructive Surgery

A

“Cosmetic”; To restore function or appearance

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9
Q

Palliative

A

Relieves or reduces pain or symptom of a disease

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10
Q

Operative Permit

A

Voluntary and informed consent or permit for surgery

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11
Q

Important condition for valid consent

A

make sure consent is signed prior to any pre-operative medication is given

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12
Q

Stress Response to surgery (GAS)

A

Norepinephrine and Epinephrine are released. (fight or flight)

^BP, ^HR, ^Cardiac Output, Bronchial Dilation, vPeristalsis

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13
Q

ACTH released as a response to surgery and leads to

A

The stimulation of cortisol and aldostrone

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14
Q

Cortisol

A

Stimulated by ACTH;

  1. Stimulates glucogenesis
  2. ^Protein breakdown and amino acids are used in healing process
  3. ^Anti-inflammatory response- ^Risk of infection
  4. ^Platelets: clots blood; Assists in healing incision- Can lead to DVT
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15
Q

Aldosterone

A
  1. Retains sodium and Water

2. Excretes Potassium

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16
Q

“GAS” releases ADH (surgery stressor)

A
  • Released by posterior pituitary
  • Retains water:
    1. maintains circulation volume
    2. v Urinary Output
    3. ^ Susceptibility to fluid overload
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17
Q

Assessing Surgical Risk: Very Young

A
  • Poorly developed lungs: less able to tolerate surgery as lungs have less range for stress;
  • ^Risk of pulmonary problems
  • Thin Skin- prone to breakdown and ^ problems with healing
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18
Q

Assessing Surgical Risk: Elderly (Aeration and Circulation)

A

Aeration:

  1. v gas exchange (02 sats)
  2. v vital capacity
  3. v Cough reflex

Circulation:

  1. v Arterial elasticity
  2. ^ Plaque Formation
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19
Q

Assessing Surgical Risk: Elderly (Renal and Sensation)

A

Renal:
v GFR: v drug excretion
*urinary stasis
*urinary incontinence

Sensation:
v sight and hearing
v short term memory
* Impaired balance

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20
Q

Assessing Surgical Risk: Elderly (Skin)

A

Thin:
^ risk of impairment
v elasticity
v collagen

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21
Q

Assessing Surgical Risk: Elderly (Mobility and Nutrition)

A

Mobility:

  • Loss of calcium from bones: prone to fractures
  • v activity: BMRv

Nutrition:

  • Dehydration
  • Malnutrition: may impair healing
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22
Q

Assessing Surgical Risk: Obese

A

Obese clients have excess adipose tissue and poor blood supply
-prolonged surgery
-prolonged excretion of anesthetic agent (stays longer in adipose tissue)
-v ventilatory function (abdominal impedes on diaphragm)
Slower healing process (v mobility and impaired circulation)

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23
Q

Assessing Surgical Risk: Underweight Client

A
  • May lack needed vitamins and proteins; impairs wound healing and risk for infection
  • Skin impairment from bony prominences
24
Q

Assessing Surgical Risk: Radiotherapy

A

Designed to v the # of cells in a given area, but also impacts the non-malignant cells

  • Risk of delayed wound healing
  • ^ Risk of skin breakdown
25
Q

Assessing Surgical Risk: Smoking

A

v Ciliary Action

  • Constricting of blood vessels from nicotine (impairs wound healing)
  • v functional hemoglobin (delay wound healing)
26
Q

Assessing Surgical Risk: Alcohol

A

Metabolism and detoxification of drugs may be delayed

  • may have poor nutrition (v wound healing)
  • at risk of alcohol withdraws (delirium tremens)
27
Q

Assessing Surgical Risk: F&E

A
  • Fluid overload (^BP, rales and bronchi, Edema)
  • Too little fluids (dehydration, vBP, GFR, delayed excretion of drugs)
  • Electrolyte imbalance: Cardiac arrhythmias (potassium deficit mostly)
28
Q

Bleeding Disorders (surgical risk)

A

Thrombocytopenia and hemophilia may both lead to uncontrolled post-op bleeding

  • Low platelet count (Thrombocytopenia)
  • Longer time for blood to clot (Hemophilia)
29
Q

Diabetes (surgical risk)

A
  • Impaired peripheral circulation contributes to impaired wound healing
  • Stress ^ blood glucose (impairs wound healing and ^ risk of infection)
30
Q

Heart Disease (surgical risk)

A

Stress ^ workload on heart, so risk of angina, MI, and CHF

31
Q

Fever (surgical risk)

A

pre-op fever may indicate an infection that can greatly impact surgery

32
Q

Upper respiratory infection (surgical risk)

A

*Anesthesia and upper respiratory infection may further ^ secretions, which can ^ recovery time

33
Q

Chronic Respiratory Disease (surgical risk)

A
  • May impair coughing

- Difficulty handling ^ secretions (coughing is important)

34
Q

Liver Disease (surgical risk)

A
  • Drug Toxicity

- Risk for impaired wound healing

35
Q

Immune Disorders (surgical risk)

A
  • ^ Risk for infection

- Delayed wound healing

36
Q

Renal Insufficiency (surgical risk)

A
  • Delayed excretion of drugs

- F&E imbalances

37
Q

Physiological Pre-Op Assessment

A
  1. Height and weight
  2. Serum protein levels
  3. vitals, chest x-ray, breath sounds
  4. History and assessment: (cardiac, hepatic, renal, endocrine, immunologic, drug therapy)
    (SEE lecture for most common pre-op screenings-pg 13)
38
Q

Psychological Pre-Op Assessment: Anxiety

A
  • Look for cues of anxiety (physiological, behavioral)

- Nurse can alley anxiety- therapeutic communication, determine source, clear up misconceptions

39
Q

Psychological Pre-Op Assessment: Fear

A

Causes:

  1. Unknown
  2. Pain and pain management- tell pt. that we will do best to manage post-op pain
  3. Concern with body image/change in image
  4. Death
  5. Anesthesia
  6. Disruption of life: having to dependent on others
40
Q

Psychological Pre-Op Assessment: Ability or Inability to cope

A
  1. Does client exhibit ability to problem solve?
  2. How have they coped with past surgeries?
  3. Have they had past surgeries?
  4. Who helped them cope?
41
Q

Psychological Pre-Op Assessment: Knowledge of surgery, anesthesia, and their role

A

-Does client know what they need to know?

42
Q

Psychological Pre-Op Assessment: Support System

A
  1. Do they have one?

2. Post-op plans

43
Q

Sociocultural Pre-Op Assessment

A
  • Support System
  • Economic
  • Plans for convalescense
44
Q

Developmental Pre-op assessment

A

Age- extremes of age are especially at risk

Gender- male could be in charge and wife won’t know how to take over and visa versa

45
Q

Spiritual Pre-Op assessment

A
  1. Consider influence of religious and philosophical beliefs on surgical risk, or reaction to need for surgical intervention
  2. Non-Judgemental nursing care
  3. Consider pastoral care referral
46
Q

Pre-Op Knowledge Deficit

A
  1. Surgical Permit
  2. Pre-op screenings and examinations
  3. Foley Catheter
  4. Pre-op diet and fluid restrictions
  5. Pre-op meds
  6. Skin prep
  7. Family Support
47
Q

Pre-Op Knowledge Deficit: Diet and Fluid Restrictions

A

A. Explain what NPO means
B. Reasoning for pre-op NPO (could vomit and aspirate)
C. SEE Table 18-8 LEWIS

48
Q

Pre-Op Knowledge Deficit: Diet and Fluid restrictions fasting periods:

A

*Some institutions will be different
*Sometimes it will be NOTHING for 8 hours
(see lecture)

49
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (Narcotics)

A
  • Morphine, Demerol
  • v pain of pre-op procedure
  • eases induction of anesthesia
  • v anesthesia required during surgery
50
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (Antiemetics)

A
  • Reglan, Zofran
  • v N/V
  • ^ GI emptying
  • v risk of aspiration
51
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (H2 receptor antagonists)

A
  • Tagamet, Pepcid, Zantac
  • Inhibits gastric secretion
  • v risk of stress ulcers

**Just about everyone in hospital is getting H2 inhibitors but may lead to anemia

52
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (Benzodiazapines)

A
  • Valium, Versed, Ativan
  • v anxiety
  • induce sedation
  • induce amnesia
53
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (Anticholinergics)

A
  • Atropine, scopolamine, glycopyrrolate
  • v Oral and respiratory secretions
  • Prevent bradycardia
54
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (Bowel Preps)

A
  • Enema, Magnesium Citrate, Antibiotics, Low-Residue diet

- Cleanse bowel prior to bowel surgery

55
Q

Pre-Op Knowledge Deficit: Pre-Op Meds: (Antibiotics)

A
  • Cefazolin
  • decreased surgical site infection if given within 60 min prior to incision
  • d/c within 24 hours of surgical incision (TO THE MINUTE, or could cause superinfection)
56
Q

Prophylactic Antibiotics

A

Antibiotics given for the purpose of preventing infection when infection is not present but the risk of post-operative infection is present.

57
Q

Anesthesia effect on lungs and respirations

A

-Increases lungs secretions and causes respirations to be shallow (could cause pneumonia or atelectasis)

Help by coughing, deep breathing, and using the incentive spirometer

Exam 3 (6 decks)

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