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Acute Health Challenges > Surgical Nursing > Flashcards

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
Q

assessing stroke risk post op

A
  • strength - squeeze fingers, move legs

- resistance - plantar and dorsiflexion

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26
Q

Pasero Opioid-Induced Sedation Scale

A

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

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27
Q

respiratory

A
  • 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
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28
Q

most common respiratory complications

A
  • atelectasis
  • pneumonia
  • pulmonary edema
  • pleural effusion
29
Q

pleural effusion

A

fluid accumulation in visceral pleura

30
Q

atelectasis

A
  • alveoli collapse limiting O2-CO2 exchange
  • can develop into pneumonia
  • cause of fever in first 48hrs
31
Q

atelectasis assessment

A
  • temp
  • respiratory pattern
  • O2 sats
  • auscultate lungs (decreased air entry at base)
  • mobility patterns
32
Q

atelectasis manifestations

A
  • pleuritic chest pain
  • dyspnea
  • fever
  • tachycardia
  • decreased breath sounds
33
Q

atelectasis interventions

A
  • education
  • pain control
  • DB & C
  • early ambulation
  • incentive spirometer
34
Q

pneumonia

A
  • inflammation of alveoli from infectious process or foreign material
35
Q

pneumonia assessment

A
  • temp
  • respiratory depth/pattern
  • auscultate lungs
  • O2 sats
  • expectorant
36
Q

pneumonia manifestations (9)

A
  • cough
  • pleuritic chest pain
  • dyspnea
  • tachypnea
  • tachycardia
  • crackles
  • decreased breath sounds
  • fever
  • bloody/purulent sputum
37
Q

pneumonia interventions

A
  • education
  • pain control
  • DB & C
  • hydration
  • early ambulation
  • incentive spirometer
  • frequent position change
  • cough out secretions
38
Q

pulmonary edema

A
  • fluid accumulation within alveoli impairing O2-CO2 exchange
39
Q

pulmonary edema assessment

A
  • ins/outs/fluid balance
  • respiratory depth/pattern
  • auscultate lungs
  • O2 sats
  • labs
  • CXR
40
Q

pulmonary edema manifestations

A
  • dyspnea
  • tachycardia
  • decreased breath sounds
  • crackles (fine to coarse)
41
Q

pulmonary edema interventions

A
  • DB & C
  • correct F&E imbalances
  • ambulation
42
Q

cardiac F&E imbalances

A
  • 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
Q

ins/outs with cardiac F&E imbalance

A
  • 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
Q

nurses role for cardiac F&E imbalance

A
  • 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
Q

common post op cardiovascular complications

A
  • Venous thrombosis embolism (VTE)
  • DVT
  • pulmonary embolism (PE)
  • stroke
46
Q

VTE

A
  • thrombus formation, increased platelet formation, stress response increases clotting
  • increased risk w immobilization and longer surgeries
47
Q

VTE assessment

A
  • mobility
  • respirations (PE)
  • neuro (stroke)
  • limbs (DVT)
48
Q

VTE manifestations PE (8)

A
  • pleuritic chest pain
  • dyspnea
  • hemoptysis
  • tachycardia
  • decreased O2 sats
  • decreased breath sounds
  • hypotension
  • anxiety
49
Q

VTE manifestations stroke

A
  • slurred speech
  • change in LOC
  • weakness
  • change in baseline
50
Q

VTE manifestations DVT

A
  • pain in limb
  • edema
  • warmth
  • pain with passive motion
51
Q

VTE interventions

A
  • education
  • pain control
  • DB & C
  • calf pumping
  • early ambulation
  • incentive spirometer
  • VTE prophylaxis protocol (meds, TEDS)
52
Q

urinary complications

A
  • 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
Q

lab tests

A

—> homeostasis for recovery

  • CBC (Hgb, WBC)
  • electrolytes (K, Na, Cl, Ca, Mg)
  • renal function (BUN, creatinine)
  • liver function (ALK, ALT phos)
54
Q

gastrointestinal complications

A
  • 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
Q

proactive GI interventions

A
  • zofran, gravol, maxeran, pantoloc

- antiemetic, GI stimulant, PPI

56
Q

ileus

A
  • cessation of bowel motility
  • post op: 2-3 days
  • paralytic: > 3days
57
Q

ileus assessment

A
  • N&V
  • bowel sounds
  • BM
  • distension
  • flatus
58
Q

ileus manifestations

A
  • poor appetite
  • absent BS
  • no flatus
  • distension
  • pain
  • N&V
59
Q

ileus interventions (7)

A
  • close assessment
  • gental surgical technique
  • early feeding
  • mobility
  • limited opioid use
  • fluid balance
  • laxative/suppositories
60
Q

anastomotic leak

A
  • 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
Q

common GI complications

A
  • ileus
  • anastomotic leak
  • bowel obstruction
62
Q

anastomotic leak assessment

A
  • VS
  • pain
  • BS/BM
  • flatus
  • distension
  • urine output
  • wound output
63
Q

anastomotic leak manifestations (9)

A
  • N&V
  • tachycardia
  • distention
  • fever
  • pain
  • wound drainage
  • pain in L shoulder
  • low BP
  • decreased urine output
64
Q

surgical wound healing

A
  • 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
Q

when are wound infections most common

A

3-5 days post op

66
Q

wound support materials

A
  • abdominal binder

- retention sutures

67
Q

dehiscence

A
  • when wound edges separate
68
Q

evisceration

A

when wound edges separate and organ protrudes through

69
Q

prophylaxis protocol for VTE

A

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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