Surgical

Question 1

• Otomy
• Laparascopic
• Orrhaphy
• Endoscopy

Answer 1

Otomy - Cutting into
Laparoscopic - Keyhole, internal of abdominal
Orrhaphy - Repair or suture
Endoscopy - Long instrument into hollow organ

Question 2

Pre Op tasks

Answer 2

• Pt interview
• Support & education
• Nursing Ax
• Pre Op checklist (name band, CONSENT, allergies, prep, charting)

Question 3

Post Op Assessment & Complications Immediately

Answer 3

• Vitals 5-15 mins
• Primary, secondary, focused Ax

Complications

• Threatened airway
• Brady/tachy cardia & apnoea
• GCS
• Haemorrhage
• Uncontrolled Pain

Question 4

Post Op Assessment & Complications Ongoing

Answer 4

• 30min obs for first 4 hours
• Pain assessment FLACC, PQRST
• Pain management (Pharmo & non Pharmo)
• Nausea and vomitting (Pharmo and non Pharmo)

Complications: 
Paralytic Illeus
- Temp impairment of gastric and bowl motility
- NIL by mouth until peristalsis resumes
- Early ambulation 
- Position pt on R) side

Question 5

General Anaesthesia

Answer 5

• Loss of sensation with LOC
• Combo of sedation, analgesia and muscle relaxants
• Requires advances airway mgmt

Question 6

Regional Anaesthesia

Answer 6

• Loss of sensation to region of body without LOC
• Nerve block achieved with admin of local anaesthetic administered to nerve bundle
• Use: invasive procedures where risk of general too great (c section, amputation)

Includes: Spinal, Epidural, Caudal

Question 7

Spinal
Epidural
Caudal

Answer 7

Spinal:

• One shot into CSF
• Surgery of lower limbs
• Side effect: Hypotension

Epidural:

• Into epidural space
• Continuous infusion for 4-5 days post op

Caudal:

• Numbs perineal area
• Post op analgesia eg. Heamorrhoidectomy

Question 8

Dermatone Levels

Bromage Score

Answer 8

Dermatone:
Ax for sensation
Each area of skin supplied by a dermatome, Nurse to assess

Bromage Score: 
Mobility of leg 
0 = Full flexion knee and feet 
1 = Just move knee 
2 = Feet only 
3 = Unable to move feet or knee

Question 9

Local anaesthetic

Answer 9

• Loss of sensation without LOC
• Sub cut or topical
• Minimally invasive procedures eg. mole removal

Question 10

Procedural Anaesthesia

Answer 10

• Similar to general, loss of sensation with LOC
• Pt can maintain own airway
• Used for short, minor procedures eg. colonoscopy

Question 11

Stages of Anaesthesia

Answer 11

1. Analgesia
   - From admin to LOC
   - Regular reps
   - Decreased awareness of pain, amnesia
2. Excitement
   - LOC
   - Enhanced reflexes (talk, vomit)
   - HR and BP increase
3. Surgical Anaesthesia (Surgery in Plane 2 passing to plane 3)
   Plane 1: light
   Plane 2: loss of blink, no response to non painful stimuli, reflex to pain
   Plane 3: Deep, no movement. Breathing assistance needed
4. Medullary Paralysis (OVERDOSE)
   - Fixed and dilated pupils
   - Cessation of breathing and circulatory collapse
   - Death

Question 12

Post anaesthetic side effects

Answer 12

Spinal/Epi/Caud:

• Headache
• Resp depression
• Hypotension
• Sensory (Dermatone and Bromage

Other: 
Resp: Hyperaemia, pneumonia
Cardio: Hypovolaemic shock 
GIT: Constipation, distension
Vasc: Wound infection, compartments 
Neuro: Delirium
Urinary: Retention