Surgery Flashcards
Classification of surgical procedures
SERIOUSNESS
Major - high risk, major body changes - eg CABG, stomach surgery
Minor - low risk, minimal intervention - eg skin excision, tooth extraction
URGENCY
Elective - planned
Urgent - needs to be performed soon
Emergent - life saving, needs now - MVA, eg. multiple trauma
Purpose of surgery
- diagnostic: e.g. angiogram, endoscopy
- palliative: remove tumours
- reconstructive/restorative: eg bone fractures
- cosmetic: e.g. rhinoplasty
PREOPERATIVE nursing assessment
- age
- allergies
- vital sign trend
- nutritional status
- habits affecting tolerance to anesthesia (opioids, caffeine, alcohol)
- presence of infections
- use of drugs that are contraindicated prior to surgery
- physiological status
- psychological state
- need for increased anesthesia, post-op pain management, decreased recovery speed
Informed consent
- based on Health and Disability Commissioner
Basic surgical consent:
- patient must be competent to make a decision
- patient must be given sufficient information
- consent/refusal must be given voluntarily
PREOPERATIVE fasting
- clear fluids (max 200ml/hr) up to 2hrs before surgery
- light breakfast up to 6hrs before surgery
- only medications approved by anaesthetist or water 3hrs before surgery
PREOPERATIVE patient preparation: interventions the day of surgery
- remove any jewellery, hair pins, clothes
- remove contact lens
- remove dentures
- remove hearing aids
- no makeup or nail polish
- give preoperative medications (loading dose analgesia)
- note the time patient leaves the floor
- ID band should be placed, or checked depending on patient status, add allergy band
PREOPERATIVE culturally competent care
- acknowledgement of culture: assessing for specific needs eg karakia
- consideration of aspects removed from body (eg hair, limbs, placenta)
- appreciating important taonga eg pounamu
Nursing roles
- circulating nurse
- scrub nurse
- registered nurse first surgical assistant
- nurse anesthetist
General anaesthesia (GA)
- used for major surgery
- loss of sensation and consciousness (hypnosis, analgesia, amnesia)
- suppression of reflexes (vomiting, coughing)
- unable to maintain airway
- e.g. propafol
Regional anesthesia (RA)
- used for major surgery
- no loss of consciousness
- less complications compared to GA
- more rapid postop recovery
- blocks pain experience for a region of the body
- includes spinal/epidural anaesthesia and peripheral nerve block
- nurses must monitor for migration of effect (eg breathing)
- e.g. bupivicaine
Local anaestheisa
- used for minor surgery
- loss of sensation without loss of consciousness
- can be ejected, applied topically, aerosolised
- e.g. lignocaine, mepivicaine, bupivicaine (Marcaine®) and ropivicaine
PACU Stage 1 recovery
- patients may be unconscious
- require 1 to 1 nursing care
- monitoring or airway-breathing-circulation-temp
- vital signs and assessments ongoing
- may require ongoing airport support
- symptom management: pain, nausea, vomiting
May transfer to stage 2 once conscious, haemodynamically stable, tolerate oral intake
PACU Aldrete Scoring System
- respiration
- O2 saturation
- consciousness
- circulation
- activity
POSTOPERATIVE nursing assessments
- Assess ABC, LOC, ability to move
- vital signs including SaO2
- pain– last dose, analgesia options, rate current pain
- wound and drainage tubes
- skin colour, appearance, moisture, temp
- urinary status: catheter, bladder distension
- position in bed: promote patient airway, comfort and mobility
- IV infusions and IV sites
- symptoms: nausea, vomiting
- emotional status
- family
- call bell
POSTOPERATIVE preventing respiratory complications
Assess for:
- work of breathing
- restlessness, confusion
- activity tolerance
Plan for:
- deep breathing and coughing
- incentive spirometry
- early mobilisation
POSTOPERATIVE preventing cardiovascular complications
Assess for:
- blood pressure, HR
- skin temperature
- fluid balance deficit/overload
- drain output
- IV therapy
- syncope
- urine output (min. 0.5mL/kg/hr)
Plan for:
- balanced fluid balance
- mobilisation to prevent clot formation = promote CO
- heparin therapy as prescribed
- bladder scanner if HNPU 6-8hrs postop
POSTOPERATIVE preventing integumentary complications
assess for:
- operative site healing, inflammation, pain
- monitor for signs of infection
plan for:
- monitor dressign for drainage
- change dressing
- daily hygiene: facilitate/assist as necessary
- mobilisation to encourage perfusion
- keeping patient warm at all times
Promote comfort and rehabilitation
- assess pain regularly throughout shift and manage within tolerable limits
- advocate for patient when analgesia is inadequate
- encourage early mobilisation and progression towards independence
- refer to discharge plan and partner with patient to progress towards realistic ADLs
- refer to community support services as necessary
