Preoperative Nursing Flashcards
Preoperative phase
begins the second the decision of surgery is made and ends when the patient is placed on the OR bed.
* can begin months before the actual surgery
Less invasive surgeries cause
reduced nosocomial infections, less stress on patient, reduced recovery time
-pt arrives 90 mins prior to surgery.
More invasive surgeries cause
a greater risk of a bad outcome especially with more comorbidity present.
Constructive/reconstructive surgery
breast augmentations
Diagnostic surgery
biopsy, exploratory, and laparoscopy
Curative surgery
excision of tumor or inflamed appendix.
Palliative surgery
to relieve pain or correct a problem
Transplant surgery
and organ removal and replace
Rehabilitative surgery
total joint replacement
Elective surgery
patient should have surgery; failure to have wouldn’t be catastrophic
- planned, has less anxiety
- repair of scars, simple hernia, vaginal repair
Emergent surgery
patient require immediate attention without delay
- severe bleeding, intestinal obstruction, gun shot wound, burns
- patient tends to have more concern and anxiety
Urgent surgery
patient requires prompt attention, within 24-30 hours.
-acute gallbladder infection, kidney or ureteral stones.
Required surgery
patient needs to have surgery, within weeks to months
-thyroid disorders, cataracts, picostatic hyperplasia without obstruction
Optional surgery
decision rests with the patient.
typically personal preference
-cosmetic surgeries
Intraoperative phase
period of time from when patient is transferred into operating room to admission to postanesthesia care unit
Postoperative phase
period of time from when patient is admitted to PACU to the time the surgeon discharges the patient.
-discharge may not be for months
Health Care Laws pertaining to surgery
HIPPA, informed consent, advanced directives, living wills
Infections pertaining to surgery
NOSOCOMIAL! insurance companies do not pay
Perfusion
SCDs, Tedhose, ambulate as soon as possible
-ambulating stimulates peristalsis.
Stress and Coping pertaining to surgery
Safety, behavioral, physiology responses.
How are they feeling?
Lifespan Developmental Considerations
Educate according to their developmental level.
Assess their ability to understand surgery.
Most of the time they need to understand they need someone else there.
True or False:
The intraoperative phase is the period of time from the decision for surgery until the patient is transferred into the operating room.
False
What begins during preadmission testing?
Teaching begins here! Verify understanding with teach back! Discharge planning starts NOW!
What is involved in the preadmission testing?
1) Initial preoperative assessment
2) Teaching appropriate patient needs
3) Verification of preoperative diagnostic testing
4) Verification of understanding of preoperative orders
5) Discussion and review of advanced directive
6) Begin discharge planning- transportation and patient care
Preoperative Assessment includes. ..
- Full history, including family history
- Physical exam
- Diagnostics
- Nutritional and fluid status
- Drug and alcohol use
- Psychosocial factors (past experience)
- Spiritual and cultural beliefs (blood transfusions, cultural association to pain)
What is included in the physical exam during the preoperative assessment?
- Vital signs
- Allergies
- Medication list (prescribed, OTC, herbals, legal/illegal)
What is included in the diagnostic testing during the preoperative assessment?
CBC, CMP, UA, EKG, Chest X-ray, Pregnancy test for every female of child bearing age (up to 60).
Malignant hyperthermia
Adverse reaction to anesthesia
- hereditary
- tachycardia (over 150), increased BP, increased temperature (up to 107* F), 75% leads to death
Gerontological Considerations
- Cardiac & circulatory compromise
- Respiratory compromise
- Renal function
- Confusion
- Fluid & electrolyte imbalances
- Skin
- Comorbidities
- Altered sensory
- Mobility restrictions
Leading cause of morbidity and mortality in elderly patients…
Cardiac and respiratory compromise
-due to less physiological reserves
What does it mean by the elderly not having enough physiological reserves?
Organs font return to normal after a disturbance
What are you to make sure to teach to the elderly?
To take their pain medications; they will not become addicts if they take as prescribed.
Bariatric
obese patient
What are the special considerations for an obese patient?
- Malnurishment
- Fatty tissues susceptible to infection
- Increased wound infections
- Risk of aspiration
What are the special considerations for an anorexic patient?
- Malnurishment
- Fluid and electrolyte imbalances
- Huge risk for bed sores
- Abnormalities all over body
Special considerations for patients with disabilities
Positioning of the patient during surgery to prevent injury or respiratory failure
Disabilities that affect body positioning
Cerebral palsy, post-polio syndrome, other neuromuscular disorders
Disabilities that affect respiratory problems
multiple sclerosis, muscular dystrophy
Special considers for patients with sensory issues
During the preoperative assessment it is important to make sure they have their hearing aids in and glasses on, keep in mind you may need to have a sign interpreter.
Special considerations for patients with comorbidities
Many older patients and obese patients have multiple diseases. Make sure they are noted and treated prior, during, or after surgery as necessary.
Special considerations for patients undergoing ambulatory surgery
They need transportation home, during preoperative assessment teaching is imperative, must anticipate needs during preoperative assessment.
Ambulatory surgery
out patient, same day, short stay surgeries, not requiring admission for an over night stay.
23 hours or less.
Special considerations for patients undergoing emergency surgery
- Little prep of patient and operative team
- Preoperative assessment may take place during recitation in the ED.
- COMMUNICATE CALMLY
- May need to receive informed consent from family member as well as history, allergies, and medications.
Alcohol Assessment & Withdrawal
CAGE questions:
May have seizure activity during surgery
C- from cage question
Have you ever felt you should CUT down on drinking?
A- from cage question
Have people ANNOYED you by criticizing your drinking?
G- from cage question
Have you ever felt GUILTY about your drinking?
E- from cage question
Have you ever needed an EYE opener first thing in the morning?
Which of the following preoperative labs should be reported to the surgeon? A. Potassium level 3.9 mEq/L B. Sodium level 149 mEq/L C. Creatinine level 2.8 mg/dL D. WBC count 8,000
C. Creatinine level 2.8 mg/dL
Elevated creatinine levels could indicate kidney failure.
Which medication classification must be assess during the preoperative period because it can cause an electrolyte imbalance during surgery? A. Corticosteriods B. Diuretics C. Anticoagulants D. Insulin
B. Diuretics
During anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance.
Latex related food allergies
Avocados, kiwi, bananas, and cannot blow up balloons.
Latex related food allergies
Avocados, kiwi, bananas, and cannot blow up balloons.
