Theory/ Patho Week 1 Flashcards
Surgery
The art and science of treating diseases, injuries, and deformities by operation and instrumentation
Surgery: Performed For
Diagnosis Cure Palliation Prevention Exploration Cosmetic improvement
Classification of Surgery: Urgency, Phases of Surgery
Urgency A Case‐ Emergency B Case‐ Urgent C Case‐ Elective Phases of Surgery Preoperative Intraoperative Postoperative
Surgery: Inpatient, Outpatient
Inpatient
◦ Admitted to hospital before or after surgery
Outpatient
◦ Performed either outside or in the hospital
◦ Discharged home after surgery
◦ Under local or general anesthesia
Informed Consent
- Legal document required for procedures or therapeutic measures
- Protects the client, nurse, physician, health care facility
- Married minors and emancipated minors may sign consent
- Spouses, children, significant other cannot sign instead of a capable adult
Pre-op Client Interview: Purpose
- Obtain health information
- Determine expectations, preparations
- Provide and clarify information on procedure
- Assess emotional state and readiness
- Identify medications and herbs taken that may affect surgical outcome
- Identify, document, and communicate results of laboratory/diagnostic tests
Nursing Assessment: Health History
Diagnosed medical conditions Previous surgeries and problems Menstrual/obstetric history Familial diseases - Conditions Reactions/problems to anesthesia (client or family)
Nursing Assessment: Current Medications
Prescription and OTC Herbs Vitamins Recreational • Drugs • Alcohol • Tobacco
Nursing Assessment: Allergies (drug and non-drug)
Screen areas:
- Risk factors
- Contact dermatitis
- Contact urticaria
- Aerosol reactions
- History of reactions suggesting latex allergy
Nursing Assessment
Vitals recorded preoperatively for baseline Bleeding/clotting times Lab reports Possible prophylactic antibiotics Clinical Indicators Identify cultural and ethnic factors that may affect surgical experience Psychosocial assessment, fears
Nursing Management: Preoperative Teaching
Client has right to know what to expect and how to participate
- Increases client satisfaction
- Reduces fear, anxiety, stress, pain, and vomiting
- Time may limit teaching
- Information given according to priority
- Observe and listen to client carefully to determine how much information is enough in each instance
Nursing Management: Preoperative Teaching
Assess what client wants to know • Priority to concerns • Usually sensory, process, and procedural information desired Teaching documented on client’s chart Instruction on deep breathing, coughing, and moving post‐operatively • Teach rationale to reinforce • Practice
Nursing Management
Inform clients and families if there will be tubes, drains, monitoring devices, or special equipment postoperatively • Enable safe care of client • Decreases client’s and family anxiety Provide client with information • Fluid/food restrictions • Possible need for enema • Need for shower preoperatively • Remove jewelry and prosthetics prior to surgery
Nursing Management: Day of Surgery Preparation
Final preoperative teaching Assessment Communication of pertinent findings to surgical team Verify signed consent Completion of all pre‐operative charting Labs History and physical exam Baseline vitals Consultation records Nurse’s notes Consent for surgery
Nursing Management: Transportation to OR
- In‐patients transported by stretcher to operating room from room
- Outpatients transported by cart, wheelchair, or may walk
Intraoperative Care
- Perioperative nursing care requires understanding of surgery, surgical interventions and the operating room environment
- Nurses must keep current on technologies, advancement in surgeries and current anaesthetic procedures
- Maintain asepsis in surgical environment
- Continue to be strong advocate for client
Physical Environment: Operating room/ suite
◦ Geographically, environmentally, bacteriologically controlled
◦ Restricted in inflow and outflow of personnel
◦ Preferred location is next to post‐ anesthesia care
unit
◦ Filters
◦ Controlled airflow
◦ Positive air pressure
◦ Materials resistant to corroding
Surgical Team
- Surgeon
- Assistant surgeon
- Registered nurse who circulates
- Registered nurse first assistant
- Registered nurse, licensed practical nurse, or surgical technician, who scrubs
- Anesthesia care provider
- Other specialized technical personnel
Classification of Anaesthesia: General/ Local anesthesia
General anesthesia ◦ Loss of sensation with loss of consciousness ◦ Skeletal muscle relaxation ◦ Analgesia Local anesthesia ◦ Loss of sensation without loss of consciousness ◦ Topically ◦ Intracutaneously ◦ Subcutaneously
Classification of Anaesthesia: Conscious Sedation, Local Anesthesia
Conscious Sedation
- Minimally depressed level of consciousness with maintenance of client’s protective airway reflexes
Local anesthesia
◦ Produces autonomic nervous system blockade
◦ Skeletal muscle paralysis in area of affected nerve
Classification of Anaesthesia: Regional Anaesthesia
Loss of sensation in body region without loss of consciousness when specific nerve or group of nerves is blocked with administration of local anaesthetic
Classification of Anaesthesia: Spinal anesthesia, Regional nerve block
Spinal anesthesia
• Injection of agent into CSF in subarachnoid space
• Usually below L2
• Autonomic, sensory, and motor blockade
• May become hypotensive from vasodilation
Regional nerve block
• Agent injected into or around specific nerve or group of nerves
Classification of Anaesthesia: Epidural Block
- Injection of agent into epidural space
- Does not enter CSF
- Binds to nerve roots as they enter and exit the spinal cord
- Client can remain fully conscious
- May be used for post‐operative pain control
Classification of Anaesthesia: IV Induction agents, Inhalation agents
IV induction agents - Induce pleasant sleep - Rapid onset Inhalation agents - Enter body through alveoli - Rapid excretion by ventilation
Classification fo Anaesthesia: Complications of inhalation agents
- Coughing
- Laryngospasm
- Bronchospasm
- Increased secretions
- Respiratory depression
Classification of Anaesthesia: Adjuncts to general anaesthesia
- Opioids
- Benzodiazapines
- Neuromuscular blocking agents - Antiemetics
Classification of Anaesthesia: Controlled hypotension, Hypothermia
Controlled hypotension
- Decrease amount of expected blood loss by lowering blood pressure during administration of anesthesia
Hypothermia
- Deliberate lowering of body temperature to
decrease metabolism
- Reduces demand for O2 and anaesthesia
Classification of Anaesthesia: Cryoanaesthesia, Hypnoanesthesia, Acupuncture
Cryoanesthesia
- Freezing localized area to block pain impulses
Hypnoanesthesia
- Hypnosis to produce alteration in pain consciousness
Acupuncture
- Decrease sensation
Nursing Management: Position of client
- Accessibility of operative site
- Administration and monitoring of anesthetic agents
- Maintenance of airway
- Correct skeletal alignment
- Prevent pressure on nerves, skin over bony prominences, eyes
- Provide for adequate thoracic excursion
- Prevent occlusion of arteries and veins
- Provide modesty in exposure
Nursing Management: Asepsis
Scrubbing, gowning, and gloving
- Cleanse hands and arms by scrubbing with detergent and brush
Basic aseptic technique
- Centre of sterile field in surgical incision
- Only sterilized items in sterile field
- Face shields
- Caps, gloves, aprons, eyewear (as appropriate)
Nursing Management: Preparing Surgical Site
Preparing surgical site
- Scrubbing or cleaning around the surgical site with antimicrobial agents
Circular motion from clean to dirty area
- Hair may be removed with clippers
Nursing Management: After Surgery
Reversal of anaesthetic agents
Anaesthesiologist and another perioperative team member accompany client to PACU and report is given
