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Surgical Nursing Flashcards

1
Q

reasons for surgery

A
  • diagnosis
  • exploration
  • prevention
  • cure/repair
  • palliation
  • cosmetic improvement
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2
Q

types of surgery

A
  • elective - choice
  • urgent - lifesaving <24 hrs
  • emergent - lifesaving immediately
  • ambulatory - day surgery
  • day of surgery admission
  • open vs lap
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3
Q

pre op prep

A
  • pre op clinic
  • tests/x-rays
  • body prep
  • risk assessment (meds, health hx)
  • teaching
  • pt changed - smoking cessation, weight loss, BG control
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4
Q

intraoperative prodecure

A
  • in OR
  • anesthetic
  • safety
  • monitoring
  • surgical procedure intervention
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5
Q

post op care

A
  • PACU
  • in pt surgical unit
  • supportive therapies
  • assessments
  • teaching
  • recovery
  • discharge plans
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6
Q

pre op considerations

A
  • meet w specialist
  • determine is good surgical candidate
  • medical hx
  • psychological state and understanding of consent
  • recovery resources
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7
Q

pre op checklist

A
  • consent
  • meds (held, adjusted)
  • NPO - nausea and aspiration
  • IV hydration if required
  • prophylactic meds (antibiotic, antiinflammatories)
  • bowel prep
  • body prep (scrub, hair removal)
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8
Q

blood thinners

A
  • weigh risks and benefits of meds vs surgery
  • hold meds for ~1 week for elective surgery
  • hold 6-12hrs for urgent surgery and admin vitamin K to increase clotting factors
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9
Q

important labs for blood thinners

A
  • INR/PT —> measure of coagulability
  • grouping to determine blood type
  • cross match to determine blood reaction
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10
Q

if INR is high…

A
  • increase risk of bleeding
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11
Q

anesthesia

A
  • general
  • local
  • regional
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12
Q

general anesthesia

A
  • sensory and consciousness

- requires intubation

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13
Q

local anesthesia

A
  • sensation

- topical, intra dermal, sub Q

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14
Q

regional anesthesia

A
  • sensation
  • regional nerves blocked
  • spinal/epidural
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15
Q

body response to anesthesia

A
  • respiration —> spams, decreased efficiency and cough reflex, increased secretions
  • decreased CO
  • urinary retention
  • N&V, decreases or stops peristalsis
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16
Q

preoperative stress response

A
  • surgery = trauma - metabolic stress response
  • release of catecholamines (epinephrine and norepinephrine) = increased clotting risk
  • increased cortisol
  • aldosterone release = Na and H2O retention
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17
Q

increased cortisol from surgical stress response

A
  • increased metabolism
  • vasoconstriction
  • hyperglycemia
  • decreased immune response
  • protein depletion delaying healing
  • pain control = decreased cortisol
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18
Q

diabetes and surgery stress

A
  • hyperglycaemia due to increased insulin resistance and gluconeogenesis = impaired healing and infection potential
  • consider DM nurse, insulin plan, BG monitoring, post op sliding scale
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19
Q

PACU care criteria for transfer to unit (7)

A
  • cardiac rhythm monitor
  • hemodynamically stable = fluid resus
  • vitals - organ perfusion
  • reversal of anesthesia = sedation score
  • successful extubation - respiratory efficiency
  • stability of surgical site/dressing/drainage
  • urine output 30ml/hr min
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20
Q

post op inpatient admission

A
  • can have specific post op orders
  • LOC & VS within 15 mins of arrival
  • surgical site and ‘things’ assessment
  • baseline respiratory and pain
  • LOC, VS, surgical site assessment Q15mins x3 sets then repeat 1hr/PRN or specific orders
  • temp can be high in first 48 hrs
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21
Q

post op personal care

A
  • sit up/dangle legs of bed day of surgery
  • bath
  • mouth care (thirst, dry mouth, meds, intubation)
  • splint/supportive tools
  • educate and inform about post op risks
  • mobility, walking 3x/day, up in chair
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22
Q

when is the most likely time for a post op complication

A

day 1-3

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23
Q

post op pain

A
  • tachycardia, HTN, increased O2 demands
  • scale and PQRST
  • pain control = improved recovery and decreased complications
  • NSAIDs + narcotics = best pain control
  • comfort measures
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24
Q

neurological

A
  • LOC
  • orientation, sedation level
  • assess return to prep baseline
  • assess changes as risk for stroke
  • emotional disturbances/delirium (older adults)
  • epidural/spinal protocols
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25
assessing stroke risk post op
- strength - squeeze fingers, move legs | - resistance - plantar and dorsiflexion
26
Pasero Opioid-Induced Sedation Scale
S = sleep, easy to arouse 1 = awake & alert 2 = slightly drowsy, easily aroused 3 = frequent drowsy, arousable, drifts to sleep during convo 4 = somnolent, minimal/no response to verbal/physical stimulation S, 1, 2 acceptable 3, 4 unacceptable
27
respiratory
- most frequent complication - predisposing factors - respiratory. disease, smoking - ensure adequate hydration to clear secretions - hypovolemia watch for resp depression w meds, sedation - hypoxemia - use O2 to keep sats as ordered
28
most common respiratory complications
- atelectasis - pneumonia - pulmonary edema - pleural effusion
29
pleural effusion
fluid accumulation in visceral pleura
30
atelectasis
- alveoli collapse limiting O2-CO2 exchange - can develop into pneumonia - cause of fever in first 48hrs
31
atelectasis assessment
- temp - respiratory pattern - O2 sats - auscultate lungs (decreased air entry at base) - mobility patterns
32
atelectasis manifestations
- pleuritic chest pain - dyspnea - fever - tachycardia - decreased breath sounds
33
atelectasis interventions
- education - pain control - DB & C - early ambulation - incentive spirometer
34
pneumonia
- inflammation of alveoli from infectious process or foreign material
35
pneumonia assessment
- temp - respiratory depth/pattern - auscultate lungs - O2 sats - expectorant
36
pneumonia manifestations (9)
- cough - pleuritic chest pain - dyspnea - tachypnea - tachycardia - crackles - decreased breath sounds - fever - bloody/purulent sputum
37
pneumonia interventions
- education - pain control - DB & C - hydration - early ambulation - incentive spirometer - frequent position change - cough out secretions
38
pulmonary edema
- fluid accumulation within alveoli impairing O2-CO2 exchange
39
pulmonary edema assessment
- ins/outs/fluid balance - respiratory depth/pattern - auscultate lungs - O2 sats - labs - CXR
40
pulmonary edema manifestations
- dyspnea - tachycardia - decreased breath sounds - crackles (fine to coarse)
41
pulmonary edema interventions
- DB & C - correct F&E imbalances - ambulation
42
cardiac F&E imbalances
- increase O2 demand = increase workload of heart - BP changes, electrolyte disturbances, dysrhythmias - hypotension = poor organ perfusion - ADH release response to decreased BP/fluid volume = fluid retention - fluid bolus, fluid resus, plasma volume expanders
43
ins/outs with cardiac F&E imbalance
- first 24-48 hrs ins can be 3x outs for cell rehydration - isotonic IV fluid to replace BV - after 48hrs outs can be 3x ins - ICF vs ECF & 3rd space - plasma proteins, edema
44
nurses role for cardiac F&E imbalance
- vitals (BP & HR) - ins/outs - urinary retention - blood/fluid loss varies, check OR record - consider all fluid sources and need for replacement (urine, NG tube, stool, blood, emesis, wound drainage) - ins/out tally Q8hrs
45
common post op cardiovascular complications
- Venous thrombosis embolism (VTE) - DVT - pulmonary embolism (PE) - stroke
46
VTE
- thrombus formation, increased platelet formation, stress response increases clotting - increased risk w immobilization and longer surgeries
47
VTE assessment
- mobility - respirations (PE) - neuro (stroke) - limbs (DVT)
48
VTE manifestations PE (8)
- pleuritic chest pain - dyspnea - hemoptysis - tachycardia - decreased O2 sats - decreased breath sounds - hypotension - anxiety
49
VTE manifestations stroke
- slurred speech - change in LOC - weakness - change in baseline
50
VTE manifestations DVT
- pain in limb - edema - warmth - pain with passive motion
51
VTE interventions
- education - pain control - DB & C - calf pumping - early ambulation - incentive spirometer - VTE prophylaxis protocol (meds, TEDS)
52
urinary complications
- 30ml/hr to perfuse kidneys - lack of production vs urinary retention - distension, bladder scan, post void residual - acute urinary retention post op from anesthesia and opioids (more common w lower abd surgery) - manifestations —> pain, spasm, decreased bladder tone, suping
53
lab tests
—> homeostasis for recovery - CBC (Hgb, WBC) - electrolytes (K, Na, Cl, Ca, Mg) - renal function (BUN, creatinine) - liver function (ALK, ALT phos)
54
gastrointestinal complications
- not limited to abd surgery - decreased peristalsis from handling bowel - distension from gas, secretions, CO2, meds - N&V common from anesthesia, meds, NPO, slow GI motility —> can delay recovery due to poor nutrition and strain - hiccups are normal from irritation of phrenic nerve (diaphragm)
55
proactive GI interventions
- zofran, gravol, maxeran, pantoloc | - antiemetic, GI stimulant, PPI
56
ileus
- cessation of bowel motility - post op: 2-3 days - paralytic: > 3days
57
ileus assessment
- N&V - bowel sounds - BM - distension - flatus
58
ileus manifestations
- poor appetite - absent BS - no flatus - distension - pain - N&V
59
ileus interventions (7)
- close assessment - gental surgical technique - early feeding - mobility - limited opioid use - fluid balance - laxative/suppositories
60
anastomotic leak
- anastomosis is the surgical creation of a connection between 2 anatomical structures - breaking apart/leaking through where 2 structures joined - early diagnosis is key to reduce mortality
61
common GI complications
- ileus - anastomotic leak - bowel obstruction
62
anastomotic leak assessment
- VS - pain - BS/BM - flatus - distension - urine output - wound output
63
anastomotic leak manifestations (9)
- N&V - tachycardia - distention - fever - pain - wound drainage - pain in L shoulder - low BP - decreased urine output
64
surgical wound healing
- pre op risks for healing - strain - tissue perfusion & nutrition post op - med-surg asepsis - healing redness vs infection redness - drainage - sang, serous, serous-sang, purulent - access, fistulas
65
when are wound infections most common
3-5 days post op
66
wound support materials
- abdominal binder | - retention sutures
67
dehiscence
- when wound edges separate
68
evisceration
when wound edges separate and organ protrudes through
69
prophylaxis protocol for VTE
UFH = unfractioned heparin monitor w PT/INR LMWH = low molecular weight heparin more precise control = safer drug when a sub-max level of anticoagulant (Lovenox, Fragmin) - may transition to oral (Xaralto)

Acute Health Challenges (7 decks)

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