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
factors that influence the clients susceptibility to stress
Increased HR: Increased CO
Peripheral vasoconstriction: increased systolic BP
Increased respiration rate
Shallow breathing
Increased epinephrine: Prolonged SNS response
Increased norepinephrine production & release
Glycogenolysis: increased blood glucose
Decreased secretions
Decreased peristalsis: decreased digestion
Psychosocial – anxiety decreases memory
legal prep for surgery
three conditions must be met for consent to be valid:
Diagnosis
Nature and purpose of the proposed treatment
Risks and consequences of the proposed treatment
Probability of a successful outcome
Availability, benefits, and risks of alternative treatments
Prognosis if treatment is not instituted.
legal responsibility of surgeon in pre-op
inform the patient of why the surgery is needed, what the expected outcomes would be, and what the potential complications may be up to and including death. Death is always a risk for any procedure, especially in the OR
RN witness responsibility
RNs can be a witness and sign the consent, but what do we witness? ONLY that a specific patient (using 2 identifiers) signed the consent on a specific date, so that signature belongs to that patient
site marking is…
mandatory when surgery is performed on a body part that has two of something
legal responsibility of nurse in pre-op
ensure the consent has been signed by both the patient and surgeon. Ensure the patient has signed prior to any administration of sedation
RN also determines & assess if the patient has any questions.
specific pre op meds
Antiemetics (Metoclopramide, ondansetron)
-Decreased nausea and vomiting
Benzodiazepines (Diazepam, Lorazepam)
-To reduce anxiety
-To induce sedation
Opioids (Morphine, Fentanyl)
-To relieve discomfort during pre op procedures
-Decrease amount of anesthetic needed for induction
Histamine H2 receptor antagonists (Omeprazole, Ranitidine)
-To increase gastric pH
-Decrease gastric volume
Antacids
-Increase gastric emptying
Anticholinergics (Atropine, Scopolamine)
-Decreased oral and respiratory secretions (atropine)
-Provides sedation
Antibiotic (Cefazoline)
-Prevent postoperative infection
pre op meds
meds required for surgery, preparing the patient both physically and psychologically
drugs for conditions that allow with a sip of water
Cardiac disease
Respiratory disease
Seizures
Hypertension (SCIP & Beta blockers)
pre op client prep
leave valuables with family or lock up with security
tape rings in place if cant be removed
ensure patient wearing ID band
REMOVE:
Dentures
Prosthetic devices
Hearing aids
Contact lenses
Fingernail polish
Artificial nails
All jewelry
patients at risk for DVT
Obese patients
Age 40 or older
History of cancer or decreased cardiac output
Decreased mobility, immobile, spinal cord injury
History of VTE, PE, varicose veins, edema
Oral contraceptives
Smoking
Hip fracture, total hip/knee surgery
post op teaching to promote recovery
deep breathing
incentive spirometer
leg exercises
thrombotic embolic stockings
sequential compression devices
pre op patient teaching
post op education begins in pre op
teach about exercises and procedures performed after surgery
prepare drains, tubes, and vascular access devices
