Surgical assessment Flashcards
1
Q
What is pain:
A
- sensation that results from the stimulation of small afferent nerve fibres called nociceptors due to trauma
- prostaglandins cause swelling and pain
2
Q
Productive vs non-productive pain:
A
Productive: a warning of injury, occurs upon tissue damage, immediate reaction
Non-productive: often caused by tissue injury, serves no purpose as a warning or diagnostic tool, person has little control over it
3
Q
Which enzymes are blocked by NSAIDs?
A
COX-1
COX-2
4
Q
What type of analgesic is ibuprofen?
A
NSAIDs (propionic acid derivative)
5
Q
Actions of prostaglandins:
A
- signal tissue damage
- pro-inflammatory
- mediate fever and increase pain perception (CNS)
- protect the gastric mucosa
- increase platelet aggregation
6
Q
Second generation NSAIDs
A
- block only COX-2
- purpose: reduce gastric mucosa damage side effect of NSAIDs.
- problems: increase risk of cardiovascular events, protective effect not as great as originally hoped.
7
Q
Adverse effects of NSAIDs
A
- GI disturbance: gastritis, bleeding, nausea, diarrhoea
- skin reactions: rash, mouth soreness
- headache, dizziness, fatigue
- platelet inhibition
8
Q
Reye’s Syndrome
A
- acquired encephalopathy of young children that follows acute febrile illness
- recurrent vomiting, agitation, lethargy
- may lead to coma and intracranial hypertension, fatty degeneration of liver
- strongly associated with aspirin use
9
Q
Disease Modifying Antirheumatic Drugs (DMARDs)
A
- used in management of rheumatoid arthritis (methotrexate, auranofin, pencillamine, sulfasalazine)
- more toxic than NSAIDs but arrests the disease process
10
Q
Mu opioid receptor mediated effects:
A
- analgesia
- reduced emotional distress
- sedation
- euphoria
- respiratory depression
- reduced GI motility
- pupil constriction
- decreased body temp
- dry mouth
- nausea and vomiting
11
Q
Partial agonist of mu opioid receptor:
A
Buprenorphine
12
Q
Antagonists of the mu opioid receptor:
A
- naloxone
- naltrexone
13
Q
Tolerance of opioids:
A
- tolerance to one mu receptor agonist confers tolerance to other agonists
- cross tolerance across the class of drugs
14
Q
Opioid-drug interactions:
A
- Other sedatives: high risk of respiratory depression & cognitive impairment
- antihypertensives: hypotensive effect of opioids can become significant in combination
15
Q
Adverse effects of opioids:
A
- decreased intestinal motility: constipation
- decreased gastric emptying, urinary retention
- histamine release: bronchoconstriction
- hypotension, bradycardia
- respiratory depression
- sedation, dizziness, headache
- dependence, tolerance
16
Q
Narcotic overdose:
A
- naloxone
- removes opioids from receptors, then binds competitively
- half-life shorter than opioids, therefore patients can rebound into overdose state
17
Q
Local anaesthetics:
A
- stop axonal conduction by blocking sodium channels in the axonal membrane
- adrenaline combined with topical anaesthetics to promote vasoconstriction
18
Q
Purposes of pre-op assessment
A
- determine psychological status for coping
- determine physiological factors and lab results contributing to operative risks
- establish baseline data to compare intra- and post-operatively
- have a complete drug history
- ensuring adequate information about procedure, risk factors, outcome
19
Q
Education for patients pre-op:
A
- Respiratory: deep breathing & coughing, position
- Movement: leg exercises, use of equipment
- Pain relief: interventions (analgesics, splinting, positioning)
- Surgical interventions: drains, IV, catheter
- Expected recovery timeframe
- Answer questions
20
Q
Consent:
A
- Voluntary
- Cover the procedure
- Informed
- Legal capacity/competence
- surgeons responsibility to obtain consent
- can be restricted
21
Q
Types of operative risks:
A
- bleeding
- infection
- wound dehiscence (non-healing)
- reaction to anaesthesia
- difficulty in rousing
- pain & discomfort
- alteration of body image
- death
22
Q
Benzodiazepines
A
- Reduce anxiety
- eg. Midazolam, Diazepam
23
Q
Opiods (pre-anaesthesia care)
A
- Analgesic
- eg. morphine, pethidine
24
Q
H2 blocker
A
- reduce gastric acid
- eg. ranitidine
25
Antiemetics
- reduce nausea & vomiting
| - metoclopramide
26
Priorities in recovery:
- respiratory function (maintain airway, lateral position)
- cardiac function
- neurological
- pain
- temperature
- surgical site
27
Prevention of postop complications:
- early mobility (improves GIT/urinary, stimulates circulation & respiratory)
- promote deep breathing & coughing, keep fluids up (prevents atelectasis, pneumonia)
28
Pre-op checklist:
- correct patient with correct bradma labels
- consent given & informed
- allergies
- monitor vital signs and deterioration
- fasting?
- remove jewellery, hearing aids, dentures, glasses, implants
- paperwork correctly labelled & present
- pathology/ECG results accessible & filed
- Xrays/scans/MRI sent to theatre
28
Complications arising from PONV:
- dehydration
- opening of surgical wounds
- BGL fluctuations
- decreased nutritional intake
- falls risk
- cardiac complications
- prolonged hospital stay
- anxiety & coping
29
Perioperative:
Refers to the three phases of surgery: preoperative, intraoperative, postoperative
30
Nurses role in patient consent:
- may be a witness
- ensures patient understands
- answer any questions
31
Risk factors for surgical patients:
- malnutrition
- cardiovascular conditions
- obesity
- blood coagulation disorder
- upper respiratory tract infections
32
Why are the elderly greater surgical risks than children/adults?
- decreased thirst
- decreased body water
- decreased kidney/liver/cardiac function
- possible malnourishment
- more likely to have chronic illness/comorbidities
- decreased sensory function
33
Types of drains:
- Jackston-Pratt
- Hemovac
- Penrose
34
Conscious sedation
Minimal depression of the level of consciousness in which the patient retains the ability to maintain a patent airway and responds to commands.
35
Atelectasis:
Occurs when ventilation is decreased and pooled secretions accumulate in a dependent area of the bronchiole and result in collapse of the alveoli
36
Discharge/home care information
- pain control
- promoting healing
- signs of infection
- nutrition
- activity level
- referrals for homecare nurses or equipment
- follow-up appointment
- numbers to call for concerns
37
Assessment of surgical wound:
- Size
- Location
- Drainage
- Appearance
- Swelling
- Pain
- Odour
