Surgical Techniques - Care of Patients with Special or Complex Needs 2-B Flashcards
includes preoperative, intraoperative, and postoperative phases
perioperative
resistance of the skin to deformation
skin turgor
patients with reproductive issues of gender issues
sexually-related disorder
patients whose small anatomical structures alter the size of equipment and instruments needed for a surgical procedure
pediatric
patients with asthma, medication allergies, or latex allergies
severe allergy
non-native speaking patient in which English is not their primary language; requires a translator; has cultural or religious practices that vary from the majority of the population
language, cultural, or religious barriers
patient who has a cognitive disorder that primarily effects reasoning, memory, perception, and problem solving due to disease processes, such as dementia and Alzheimer’s disease
geriatric
patient who faces humiliation or embarrassment because of their size, often causing them to delay seeking health care, sometimes with devastating consequences
bariatric
patients with anemia, hemophilia, or bloodborne pathogen diseases
hematological disorder
patients with diabetes, anorexia, bulimia, liver dysfunctions, and renal dysfunctions requiring dialysis
metabolically impaired
patients with neuromuscular disease, paralysis, physical deformities that are congenital in nature or acquired and sensory impairment
physically challenged
patients with Down’s syndrome, PTSD, OCD, ADHD, fetal drug or alcohol syndrome
mentally or emotionally challenges
patients who have an infectious disease that could spread microorganisms to staff or other patients
isolation
patients with physical wound or injury, such as a fracture or blow
trauma
includes immunocomprimised patients, such as cancer patients on chemotherapy, patients with AIDS or who are HIV positive, transplant patients on immune-suppression medications, and burn patients
aseptically critical
patients who consume a substance in amounts or with methods neither approved nor supervised by medical professionals
substance abuse
pregnancies with a greater chance of complications
high-risk pregnancy
in this stage, the world becomes meaningless and overwhelming, and life makes no sense. The patient is in a state of shock.
denial
Empty feelings present themselves in this stage, and grief enters on a deeper level. This feels as though it will last forever.
depression
This stage is marked by calm and acknowledgment. This is not a period of happiness and must be distinguished from depression.
acceptance
Patients in this stage may feel guilty or remorse that they did not change their lifestyle or heed warning signs.
anger
In this stage, the normal reaction to feelings of helplessness and vulnerability is often a need to regain control or postpone death.
bargaining
In this stage, patients experience a reaction to practical implications relating to the illness or loss. Sadness and regret pre-dominate this stage.
depression
This stage is often confused with the notion of being “all right” or “OK” with what has happened.
acceptance
The first reaction to learning of terminal illness or the death of a cherished loved one is to disallow the reality of the situation.
denial
This is the second stage of grieving.
anger
Secretly, patients in this stage may make a deal with God or a higher power in an attempt to postpone the inevitable.
bargaining
This stage is about acknowledging that an illness is a reality or that a loved one is physically gone and recognizing that this new reality is the permanent reality.
acceptance
Aging patients may be mentally confused for a variety of reasons, so it is important to speak ______ and distinctly.
slowly
Many aging patients experience problems _____, making it important for you to speak loudly and clearly.
hearing
Handle aging patients gently but _____, without rushing them.
firmly
Allow patients to be as _____ as possible.
independent
Specialized monitoring equipment and temperature control units may be used on aging patients to more closely monitor their _____ _____ and alert the OR team to any emergencies.
vital signs
Aging patients are more prone to postoperative complications such as hypotension, _______, cerebral edema, and hypoxemia.
hypothermia
Aging patients present special challenges to the anestheologist because fitting a _____ may be difficult due to loss of teeth.
mask
Aging patients have a diminished and slower _____ _____; therefore they are more inclined to thrombus formation and my require antiembolic stockings.
heart rate
Patients need to be _____, not pulled, during transfer to and from the operating table since skin is thin and sensitive.
lifted
Decrease of blood supply to kidneys inhibits _____ and makes patient susceptible to infections.
filtering
Blood loss must be monitored and promptly _____.
replaced
Aging patients are more prone to _____ infections.
respiratory
Positioning an aging patient can be a challenge, not just because their skin is more easily damaged but for reasons of structural integrity. _____ become porous and less dense.
Bones
A 36-year-old male Buddhist monk comes in for a same-day hernia repair. Male monks cannot come in contact with a woman, since this can be interpreted as a breaking of vows. Which of the following is NOT an option in caring for this patient?
1) have the patient self-bathe as part of pre-op prep
2) have anestheologist induct the patient early, since there is a mixed gender surgical team
3) observe surgeon’s request for an all-male staff
4) all of the above
2) have anestheologist induct the patient early, since there is a mixed gender surgical team
A horse tramples a 12-year-old girl, resulting in massive internal injuries. Her parents are out of town, but the camp counselors have spoken with them and they are on a flight home. After being rushed to the hospital, the surgical team discovers pooled blood in her abdomen and significant damage to her kidney. Her medical alert card state that under no circumstances is she to receive blood because of her parents’ beliefs. The counselor, the girl’s legal guardian, has refused to sign the release at the parents’ explicit direction. The tension between the high value placed on life (Hippocratic oath, life devoted to healing) in direct opposition with a religious belief that places an equally high value on the soul and the hereafter. Which of the following is the most defensible position for the surgical team to take?
1) administer a blood transfusion, since the patient’s life is at stake.
2) perform all necessary life-saving surgeries without a blood transfusion
3) stop surgery and sew her up
4) coerce the camp counselor into signing a waiver to allow for blood transfusion
2) perform all necessary life-saving surgeries without a blood transfusion
A 72-year-old Native American grandmother arrives carrying a dream catcher her young grandson has made for her especially for this surgery. She wants to bring it into surgery. A 5-year-old boy from India is being assisted with his pre-operative routine and the nurse goes to cut several strings ties to each of his wrists. He draws back in fear, crying out that she will cut his soul. Which of the following are other examples of items requiring special exemption or a mutually acceptable compromise?
1) medicine bundles
2) bits of red ribbon
3) special charms on chains, bracelets, bundles, or talismans
4) rosary beads
5) all of the above
5) all of the above
A description of those who need special language, cultural, or religious considerations include all of the following EXCEPT:
1) those with cultural or religious practices that vary from the minority of the local population
2) those whose language is not the primary language of the local population
3) those whose religious or cultural customs prevent them from receiving blood transfusions or donated organs
4) those who may not completely understand doctor’s orders because they are non-native speakers
1) those with cultural or religious practices that vary from the minority of the local population
permanent loss of consciousness, permanent coma, and in a persistent vegetative state (PVS)
higher brain death
results from the cessation of heart function
cardiac death
irreversible loss of all functions of the brain, including the brain stem
whole brain death
A DNR order indicates that the patient and/or the family has made a decision to _____ lifesaving efforts.
decline
The official order is charted in the patient’s medical records after the DNR document has been _____ by the patient or a family member.
signed
DNR orders can be incorporated into a(n) _____ _____, or by informing hospital staff.
advance directive
Many types of surgery provide _____ benefits to patients who either will not survive long-term or who do not wish resuscitation in the OR, so the precise procedures that can and cannot be performed should be designed to prevent ambiguity.
pallative
Unless instruction for a DNR are in effect, hospital staff will make every effort to help patients whose hearts have stopped or who have stopped _____.
breathing
_____ issues may arise if a DNR order is not in place and when the decision is left to the family members.
Ethical
Patients who benefit from a DNR order are those who have _____ or other debilitating illnesses.
terminal
The decision to become an organ donor is personal. In many states, this decision is verified on the individual’s _____ _____ or other identification cards.
driver’s license
Organ and tissue donation can occur with a decreased donor, who can give kidneys, pancreas, liver, lungs, heart, intestinal organs, and with a live donor, who can give a _____ or a portion of the liver, lung, or intestine.
kidney
A donor must be free of _____ _____. At the time of death, the donor’s families will be asked to assist in completing a health history of the donor.
infectious disease
The process for procurement is organized through tissue and organ procurement agencies who locate _____, register recipients, and organize procurements.
donors
A computer program matches donor organs with recipients based on certain characteristics. These include _____ type, tissue type, height, and weight. The length of time the patient has been waiting, the severity of the patient’s illness, and the distance between the donor’s and the recipient’s hospitals also figure into who is the best match for a specific organ.
blood
At the hospital, the donor is maintained on _____ support and the condition of each organ is carefully monitored by the hospital medical staff and the procurement coordinator.
life
The _____ operation takes place after the transport team arrives t the hospital with the new organ.
transplant
