Systems Assessment

Question 1

GI assessment pre op?

Answer 1

Unpredictable, laparoscopic may become open

Prep needed and done?

NPO status

If stoma is needed has site been marked?

Question 2

Why are GI surgeries increased at higher risk of complications

Answer 2

Altered nutritional status

• causing increased risk of infection, poor wound healing, pressure injuries

Question 3

Why is it important for stoma sites to be parked prior to surgery?

Answer 3

Placed in optimal site within rectus muscle

• decrease hernia
• avoids placement across skin folds to to prevent appliance leaks
• visibly accessible

Question 4

Focused assessment for GI?

Answer 4

Skin integrity 
Hair distribution ?clipping 
Scars 
Distension 
Palpation -rigidity 
Localized pain

Question 5

Hepatobiliary system surgery?

Answer 5

Biliary tract, pancreas, liver, spleen

Poor bleeding and coagulation
- hard to achieve hemostasis

Question 6

Hernia surgery?

Answer 6

Multiple surgical locations

Pain described as “burning” often feels like foreign body

Question 7

Gyne and ob surgery?

Answer 7

Pregnancy test pre op for all women in child bearing years

Ensuring privacy

Respecting cultural beliefs, personal values

Recognizing signs of violence

Question 8

Genitourinary surgery?

Answer 8

Kidneys, ureters, bladder, urethra and prostate

Hard positioning in surgeries

Large amount of irrigation may cause electrolyte imbalances

Last void

Question 9

Thyroid surgery?

Answer 9

Hyperthyroid- accelerated VS
- large thyroid may cause shift of trachea causing difficult airway

• increased bleeding during surgery may cause compromised airways
• have carts in room

Fire risk

Question 10

Parathyroid surgery?

Answer 10

Similar to thyroid sx

Post op consideration for hypocalcemia
- Chvostek sign - reflexes/twitching, numbness of extremities + lips

Question 11

Breast surgery?

Answer 11

Involve patient as possible
- site marking

Emotional considerations
Skin assessment

Question 12

Ophthalmic surgery?

Answer 12

Eyes

Question 13

Otorhinolaryngologic surgery?

Answer 13

Oto - ears

Rhino - nose

Laryngo - throat

Question 14

Orthopaedic surgery?

Answer 14

Mobility considerations
Correct site
Skin
ROM - positioning

Question 15

Thoracic surgery?

Answer 15

Respiratory 
Focused assessment 
Pre op ventilation and perfusion studies to maintain effective gas exchange during surgery 
?smoker 
Specimen collection

Question 16

Vascular surgery?

Answer 16

Tissue perfusion 
Pedal pulses 
Risk of bleeding - labs 
Marked site 
Increased risk of pressure injury 
Poor ROM

Question 17

Cardiac surgery?

Answer 17

Labs 
Medications 
Pulses 
Edema 
Respiratory assessment 
- SOB
LOC 
- poor perfusion

Question 18

Maslows hierarchy of needs?

Answer 18

• pt readiness to learn

TOP
- self actualization
- ego/self esteem 
- social/love 
- safety/security 
- biological 
BOTTOM

Question 19

Important assessment questions before surgery?

Answer 19

NPO status 
Jewelry / implants 
Mobility / ROM
Last void 
Loose teeth 
Personal belongings

Question 20

NPO guidelines for American society of anesthesia?

Answer 20

Clear fluids - 2hrs 
Breast milk - 4hrs 
Infant formula/nonhuman milk - 6hrs 
Light meal - 6hrs 
Normal food - 8hrs 

*aspiration risk

Question 21

Why are jewelry and implants important to know about pre op?

Answer 21

Provide alternate pathway for electrical current

Could be lost

Question 22

Wash and oral care before surgery?

Answer 22

Decreased SSI’s

Decreased pneumonia

Question 23

Informed consent sheet?

Answer 23

Information about procedure, risks/benefits, alternative treatment

• legal guardian if < 19
• competency
• emergency surgery

Blood consent

Question 24

MOST in the OR?

Answer 24

Sometimes waive DNR for surgery

Question 25

How can patients help reach pre op optimization?

Answer 25

Nutrition
Exercise
Stop smoking/drinking
Managing co morbidities