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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
Assessing Surgical Risk: Smoking
v Ciliary Action - Constricting of blood vessels from nicotine (impairs wound healing) - v functional hemoglobin (delay wound healing)
26
Assessing Surgical Risk: Alcohol
Metabolism and detoxification of drugs may be delayed - may have poor nutrition (v wound healing) - at risk of alcohol withdraws (delirium tremens)
27
Assessing Surgical Risk: F&E
- 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
Bleeding Disorders (surgical risk)
Thrombocytopenia and hemophilia may both lead to uncontrolled post-op bleeding - Low platelet count (Thrombocytopenia) - Longer time for blood to clot (Hemophilia)
29
Diabetes (surgical risk)
- Impaired peripheral circulation contributes to impaired wound healing - Stress ^ blood glucose (impairs wound healing and ^ risk of infection)
30
Heart Disease (surgical risk)
Stress ^ workload on heart, so risk of angina, MI, and CHF
31
Fever (surgical risk)
pre-op fever may indicate an infection that can greatly impact surgery
32
Upper respiratory infection (surgical risk)
*Anesthesia and upper respiratory infection may further ^ secretions, which can ^ recovery time
33
Chronic Respiratory Disease (surgical risk)
- May impair coughing | - Difficulty handling ^ secretions (coughing is important)
34
Liver Disease (surgical risk)
- Drug Toxicity | - Risk for impaired wound healing
35
Immune Disorders (surgical risk)
- ^ Risk for infection | - Delayed wound healing
36
Renal Insufficiency (surgical risk)
- Delayed excretion of drugs | - F&E imbalances
37
Physiological Pre-Op Assessment
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
Psychological Pre-Op Assessment: Anxiety
- Look for cues of anxiety (physiological, behavioral) | - Nurse can alley anxiety- therapeutic communication, determine source, clear up misconceptions
39
Psychological Pre-Op Assessment: Fear
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
Psychological Pre-Op Assessment: Ability or Inability to cope
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
Psychological Pre-Op Assessment: Knowledge of surgery, anesthesia, and their role
-Does client know what they need to know?
42
Psychological Pre-Op Assessment: Support System
1. Do they have one? | 2. Post-op plans
43
Sociocultural Pre-Op Assessment
- Support System - Economic - Plans for convalescense
44
Developmental Pre-op assessment
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
Spiritual Pre-Op assessment
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
Pre-Op Knowledge Deficit
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
Pre-Op Knowledge Deficit: Diet and Fluid Restrictions
A. Explain what NPO means B. Reasoning for pre-op NPO (could vomit and aspirate) C. SEE Table 18-8 LEWIS
48
Pre-Op Knowledge Deficit: Diet and Fluid restrictions fasting periods:
*Some institutions will be different *Sometimes it will be NOTHING for 8 hours (see lecture)
49
Pre-Op Knowledge Deficit: Pre-Op Meds: (Narcotics)
* Morphine, Demerol - v pain of pre-op procedure - eases induction of anesthesia - v anesthesia required during surgery
50
Pre-Op Knowledge Deficit: Pre-Op Meds: (Antiemetics)
* Reglan, Zofran - v N/V - ^ GI emptying - v risk of aspiration
51
Pre-Op Knowledge Deficit: Pre-Op Meds: (H2 receptor antagonists)
* 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
Pre-Op Knowledge Deficit: Pre-Op Meds: (Benzodiazapines)
* Valium, Versed, Ativan - v anxiety - induce sedation - induce amnesia
53
Pre-Op Knowledge Deficit: Pre-Op Meds: (Anticholinergics)
* Atropine, scopolamine, glycopyrrolate - v Oral and respiratory secretions - Prevent bradycardia
54
Pre-Op Knowledge Deficit: Pre-Op Meds: (Bowel Preps)
* Enema, Magnesium Citrate, Antibiotics, Low-Residue diet | - Cleanse bowel prior to bowel surgery
55
Pre-Op Knowledge Deficit: Pre-Op Meds: (Antibiotics)
* 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
Prophylactic Antibiotics
Antibiotics given for the purpose of preventing infection when infection is not present but the risk of post-operative infection is present.
57
Anesthesia effect on lungs and respirations
-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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