Surgical Patients Flashcards
What is the difference between Ambulatory care, surgical daycare and same day admit?
Ambulatory care: quick procedure, only requires partial sedation
Surgical Daycare: doesn’t require hospital bed
Same Day Admit: spend time in the hospital
Explain the difference in procedure between Elective surgery and emergency surgery
With an elective procedure, pt arrives in Surgical Daycare (SDC) as planned pre-op, where they head to the OR, then the PACU, and then either inpatient SDC or outpatient SDA, depending on the surgery.
With an emergency procedure, the pt. arrives in the ER, where they head to the OR, then PACU, then SDC or SDA
List the 6 purposes of surgery
- Cosmetic– improvement of physical body
- Cure or repair– elimination or repair
- Diagnostic– determine presence or extent
- Exploration– surgical examination
- Prevention– removal of…
- Palliation– symptoms alleviated
Explain the difference between Urgent, emergency and salvage surgery.
emergency– scheduled within 2 hrs
urgent– required within 24 hrs
salvage– death is imminent unless pt can be taken to the OR immediately
A patient has been admitted as a “stable” GI bleed. What classification for timing will this patient be indentified under?
Emergency surgery
What is the role of a circulating nurse?
assist the team to create and maintain a safe environment for the patient
**Must be an RN
Explain the difference between unrestricted, semi-restricted and restricted sections of the surgical suite
unrestricted: street clothes, can interact with scrubs
semi-restricted: authorized personnel in surgical attire with head covered
Restricted: authorized personnel in surgical attire with head covered and with masks on
What are the most common positions for surgery prep?
supine, lithotomy, sitting, prone, lateral
Discharge from the PACU post-op is determined by a scale including what 5 assessments?
- Patient Mobility
- Respiratory status
- Curculation
- Consciousness
- Pulse Oximetry
What specific complication is associated with laparoscopic surgeries? If my patient presents with this, how can I intervene?
Referred shoulder pain r/t CO2 retention.
- place pt. in Sims’s position (L side with R knee flexed)
- Deep breathing
- Mobilization
What are the 3 most common post-op complications to look for?
- Pain
- Nausea
- Atelectasis
Post-op Priority assessments
- ABC’s
- LOC and full neuro
- Full set of Vitals
- Surgical site, drains, tubes, dressings
Your patient is c/o severe pain after arriving from the PACU. To determine order of care, create a nursing diagnosis, including appropriate interventions
Acute pain r/t surgical intervention, tissue damage m/b pt. c/o deep, stabbing pain 9/10 on the pain scale
- Dr. Orders for pharmaceuticals
- non-pharmaceuticals (warm blanket, massage)
- management of med. side effects.
Define atelectasis
a condition characterized by the collapse of alveoli caused by obstruction from retained secretions or decreased inflation
Your patient has just returned from the PACU. When completing your initial set of vitals, her SaO2 is 88%. Write a nursing diagnosis for this situation, and explain how you would intervene.
Impaired gas exchange r/t decreased mobility, pain, hypoventilation, and anesthesia m/b fine crackles, decreased O2 sats and shortness of breath
- Provide oxygen via nasal prongs to achieve and maintain O2 sats of 92% or greater
- Raise Head of Bed
- Deep breathing and coughing 10 times every hour while awake
- Incentive spirometry 10-15 times Q 2-3 hrs
- Mobilization
- Adequate hydration (always check in case pt. is on fluid restrictions)
FUN FACT!
** adequate hydration decreases risk of atelectasis in our post-op patients!!**
Your patient is presenting with dry membranes, low BP and urine output, tachycardia and excessive thirst. Write a nursing diagnosis, and prioritize care for this patient
Hypotension or Hypovolemia r/t decreased circulating volume, post op nausea and vomiting, effects of anesthetic m/b dry membranes, hypotension, decrease urine output, tachycardia and excessive thirst.
- Assessment and monitoring of Vitals
- Assessment and monitoring of intake/output
- Monitoring of ordered blood work, especially Hgb and electrolytes
- If blood work hasnt been ordered, request it from the Dr.
Your patient is POD x 1. In your morning head to toe assessment, you notice his legs are slightly swollen and he c/o calf tenderness, and his feet are cold to the touch. Write a nursing diagnosis for this circumstance and explain what you would do.
Impaired limb circulation or decreased peripheral perfusion r/t decreased mobilization and dehydration m/b pain, redness and swelling to the calf and patient c/o discomfort
- Early mobilization (POD#1 if possible!)
- Leg exercises 10-12 times Q1-2hrs while awake
- SCD’s as per Dr. orders
- LMWH as ordered
- Ensure adequate hydration via IV or PO (As long as it is not contraindicated)
Who is at highest risk for Post-op Nausea and vomiting?
- Females
- non-smokers
- opioid use
- Hx of PONV
- Hx of motion sickness
- Longer surgeries
What specific procedures put an individual at higher risk for PONV?
laparoscopic
neurosurgery
breast
plastic surgery
Your patient had surgery this morning. She just rang her call bell, and as you enter the room, she starts to vomit. After helping her clean up, you realize you must intervene. What might you do?
Post-op nausea and vomiting r/t effects of anesthetic and opioids, pre-op fasting, surgical intervention and delayed gastric emptying
- Anti-emetics around the clock as per dr. orders
- Advancement of diet starting with ice chips, then clear fluids after surgery
- maintain IV fluids
- reduce fowl smells in patient room
Which anti-emetic is most effective for chemical induced N&V?
Ondansetron
How does metoclopramide work as an anti-emetic?
blocks dopamine receptors in chemoreceptor zone and stimulates GI motility
USED FOR CANCER
Your patient is post-op day 2, and is worried because she has not yet had a bowel movement. Write a nursing diagnosis, and plan appropriate nursing interventions
decreased return of bowel motility r/t effects of anesthetic, decreased mobility, side effects of opioids, pain, pre-op fasting m/b lack of flatus and abdominal distention and discomfort
- early and frequent mobilization, at least up in chair for meals and walk in hall 2 times per day
- effective pain management to allow for mobilization
- abdominal assessment
- repositioning in bed
- advancing diet at appropriate speed
