Systems Assessment Flashcards
GI assessment pre op?
Unpredictable, laparoscopic may become open
Prep needed and done?
NPO status
If stoma is needed has site been marked?
Why are GI surgeries increased at higher risk of complications
Altered nutritional status
- causing increased risk of infection, poor wound healing, pressure injuries
Why is it important for stoma sites to be parked prior to surgery?
Placed in optimal site within rectus muscle
- decrease hernia
- avoids placement across skin folds to to prevent appliance leaks
- visibly accessible
Focused assessment for GI?
Skin integrity Hair distribution ?clipping Scars Distension Palpation -rigidity Localized pain
Hepatobiliary system surgery?
Biliary tract, pancreas, liver, spleen
Poor bleeding and coagulation
- hard to achieve hemostasis
Hernia surgery?
Multiple surgical locations
Pain described as “burning” often feels like foreign body
Gyne and ob surgery?
Pregnancy test pre op for all women in child bearing years
Ensuring privacy
Respecting cultural beliefs, personal values
Recognizing signs of violence
Genitourinary surgery?
Kidneys, ureters, bladder, urethra and prostate
Hard positioning in surgeries
Large amount of irrigation may cause electrolyte imbalances
Last void
Thyroid surgery?
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
Parathyroid surgery?
Similar to thyroid sx
Post op consideration for hypocalcemia
- Chvostek sign - reflexes/twitching, numbness of extremities + lips
Breast surgery?
Involve patient as possible
- site marking
Emotional considerations
Skin assessment
Ophthalmic surgery?
Eyes
Otorhinolaryngologic surgery?
Oto - ears
Rhino - nose
Laryngo - throat
Orthopaedic surgery?
Mobility considerations
Correct site
Skin
ROM - positioning
Thoracic surgery?
Respiratory Focused assessment Pre op ventilation and perfusion studies to maintain effective gas exchange during surgery ?smoker Specimen collection
Vascular surgery?
Tissue perfusion Pedal pulses Risk of bleeding - labs Marked site Increased risk of pressure injury Poor ROM
Cardiac surgery?
Labs Medications Pulses Edema Respiratory assessment - SOB LOC - poor perfusion
Maslows hierarchy of needs?
- pt readiness to learn
TOP - self actualization - ego/self esteem - social/love - safety/security - biological BOTTOM
Important assessment questions before surgery?
NPO status Jewelry / implants Mobility / ROM Last void Loose teeth Personal belongings
NPO guidelines for American society of anesthesia?
Clear fluids - 2hrs Breast milk - 4hrs Infant formula/nonhuman milk - 6hrs Light meal - 6hrs Normal food - 8hrs
*aspiration risk
Why are jewelry and implants important to know about pre op?
Provide alternate pathway for electrical current
Could be lost
Wash and oral care before surgery?
Decreased SSI’s
Decreased pneumonia
Informed consent sheet?
Information about procedure, risks/benefits, alternative treatment
- legal guardian if < 19
- competency
- emergency surgery
Blood consent
MOST in the OR?
Sometimes waive DNR for surgery
How can patients help reach pre op optimization?
Nutrition
Exercise
Stop smoking/drinking
Managing co morbidities
