TOPIC 2 - pre op Flashcards
three phases of preoperative phase
pre-op, intra-op, post-op
surgical locations
inpatient: same day admission or patients who are already in the hospital
ambulatory: outpatient or same day surgery (more than 1/2 of procedures)
MD office setting
trauma levels
1- will take everything, multi-system trauma, have in house 24/7 OR team
2- single system trauma, still have 24/7 OR team
3-no longer has any in house staff, limited service (no neuro or cardiac), no trauma or ambulance patients, OR has 1hr from the time of arrival to take patient to OR
4-no onsite staff, limited service, walk in patient only
elective surgery
not emergency, has been scheduled, plenty of time to prepare, in outpatient and MD offices
urgent surgery
must go to surgery within 6 hours for a life or limb threatening surgery
patient tends to be stable and wait in the ER
emergent surgery
true emergency surgeries where there will be a loss of life or limb within one hour if the patient isn’t take to surgery
patients tend to be very unstable
extent of surgery
simple, radical, minimally invasive, robotic assisted surgery, telehealth
reasons for surgery
diagnostic- determines origin and cause of disorder
curative-resolve health problem by repairing or removing cause
restorative- improve functional ability
palliative-relieve symptoms of disease process but does not cure
cosmetic-alter and enhance personal appearance
preoperative phase
begins when patient is scheduled for surgery and ends at time of transfer to operating room
nurses functions as educator/advocate/promoter of health
setting: inpatient or outpatient ambulatory
GOAL: protect from injury and infection, reduce anxiety, and educate the patient
what is the primary purpose of the client interview
client safety, consents, baseline of condition, identify risks, complete pre-op checklist, determine patients expectations of surgery and assess emotional state
goal of pre-op phase
protect from injury and infection, reduce anxiety, and educate the patient
body system assessment pre-op
neuro: assess LOC
cardiac: obese pts need higher doses, assess hx of clots and MI’s
resp: obese pt with sleep apnea can have complications, past smoker
renal/GU: kidney impair = inhibit excretion
musculoskeletal: can pt assume necessary positions for surgery?
nutrition: malnutrition and obesity increase risk
psychosocial: anxiety
how to establish a baseline in the patient interview
assess allergies - foods, chemicals, pollen, latex
meds - anticoagulants, narcotics, seizure control, heart disease, herbs and vitamins
health hx, head to toe, focus on body system that surgery will be done on, report abnormal assessments to surgeon team, risks
common fears of patients going into surgery
death, pain and discomfort, mutilation or altered body image, anesthesia, disruption of life functioning
labs and diagnostic testing
Chest x-ray
Electrocardiogram
Blood - CBC - RBC, Hgb, Hct, WBC
Electrolytes
Creatinine
Blood urea nitrogen
Clotting studies – INR/PT, aPTT
ABGs (arterial blood gasses)
Type, screen, and crossmatch
Liver function tests
Blood glucose
Urinalysis
Pregnancy test
Pulmonary function studies
CT, MRI, or other appropriate diagnostic test results
