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NUR5111 > Surgical assessment > Flashcards

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
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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

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3
Q

Which enzymes are blocked by NSAIDs?

A

COX-1

COX-2

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4
Q

What type of analgesic is ibuprofen?

A

NSAIDs (propionic acid derivative)

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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
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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.
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7
Q

Adverse effects of NSAIDs

A
  • GI disturbance: gastritis, bleeding, nausea, diarrhoea
  • skin reactions: rash, mouth soreness
  • headache, dizziness, fatigue
  • platelet inhibition
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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
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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
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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
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11
Q

Partial agonist of mu opioid receptor:

A

Buprenorphine

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12
Q

Antagonists of the mu opioid receptor:

A
  • naloxone

- naltrexone

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13
Q

Tolerance of opioids:

A
  • tolerance to one mu receptor agonist confers tolerance to other agonists
  • cross tolerance across the class of drugs
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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
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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
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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
  1. Voluntary
  2. Cover the procedure
  3. Informed
  4. 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
Q

Antiemetics

A
  • reduce nausea & vomiting

- metoclopramide

26
Q

Priorities in recovery:

A
  • respiratory function (maintain airway, lateral position)
  • cardiac function
  • neurological
  • pain
  • temperature
  • surgical site
27
Q

Prevention of postop complications:

A
  • early mobility (improves GIT/urinary, stimulates circulation & respiratory)
  • promote deep breathing & coughing, keep fluids up (prevents atelectasis, pneumonia)
28
Q

Pre-op checklist:

A
  • 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
Q

Complications arising from PONV:

A
  • dehydration
  • opening of surgical wounds
  • BGL fluctuations
  • decreased nutritional intake
  • falls risk
  • cardiac complications
  • prolonged hospital stay
  • anxiety & coping
29
Q

Perioperative:

A

Refers to the three phases of surgery: preoperative, intraoperative, postoperative

30
Q

Nurses role in patient consent:

A
  • may be a witness
  • ensures patient understands
  • answer any questions
31
Q

Risk factors for surgical patients:

A
  • malnutrition
  • cardiovascular conditions
  • obesity
  • blood coagulation disorder
  • upper respiratory tract infections
32
Q

Why are the elderly greater surgical risks than children/adults?

A
  • decreased thirst
  • decreased body water
  • decreased kidney/liver/cardiac function
  • possible malnourishment
  • more likely to have chronic illness/comorbidities
  • decreased sensory function
33
Q

Types of drains:

A
  • Jackston-Pratt
  • Hemovac
  • Penrose
34
Q

Conscious sedation

A

Minimal depression of the level of consciousness in which the patient retains the ability to maintain a patent airway and responds to commands.

35
Q

Atelectasis:

A

Occurs when ventilation is decreased and pooled secretions accumulate in a dependent area of the bronchiole and result in collapse of the alveoli

36
Q

Discharge/home care information

A
  • 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
Q

Assessment of surgical wound:

A
  • Size
  • Location
  • Drainage
  • Appearance
  • Swelling
  • Pain
  • Odour

NUR5111 (14 decks)

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