Unit 2 he Surgical Patient, the Physical Environment, and Preoperative Patient Care Flashcards
Why is it important to never lose sight of the total person of the surgical patient?
We must never lose sight of the total person of our patients to fulfill our moral and ethical obligations to them
List factors that impact the surgical patient’s stress level.
Type, nature, and severity of the illness, trauma or disease
Patient’s previous experiences with illness, trauma, or disease, including previous surgery
Patient age
Pediatric patients experience surgery differently than adolescents or adults
Environmental differences
Hospital versus home; acute care versus ambulatory
Family/social support
Financial impact of provider; dependent role for care
Economic factors
Ability to earn one’s living, temporary or long-term
Religious beliefs
Attitudes and views of illness, life, death
Trauma – why did this happen to me?
May affect treatment options (e.g., blood products)
List common patient coping mechanisms to the stress of surgery.
Denial
Avoid doctors; ignore symptoms
Rationalization•
E.g., this cancer wasn’t due to smoking
Regression
Excessive crying, pouting, clingy
Repression
Won’t discuss the issue; escaping; avoidingDefine the three medically accepted stages of death.
Cardiac death
Irreversible loss of heartbeat and respiration; permanent absence of heartbeat and respiration
(FYI: must be sustained artificially for organ donors)
Higher-brain death
Irreversible loss of higher brain function; brain stem functions of heartbeat, respirations, and blood pressure remain without artificial support
Whole-brain death
Irreversible loss of all brain functions; generally accepted legal definition of death
Outline steps taken when a patient death occurs in the operating room.
First 2 steps are not stated clearly in text:
Surgeon indicates time of death
Anesthesia ceases
Notify OR supervisor (or house supervisor when on call)
Supervisor alerts hospital chaplain
Surgeon will leave to notify family directly
Wound is closed (all in one layer), drapes removed
Items disconnected but left in place
cut ground pad wire but leave pad in place
tie off and cut IV tubing but leave cannula in place
Clean patient’s body
Replace hospital gown and blanket (in case family wants to view body)
Move patient’s body to transport stretcher and release to transporter/s
Body taken to hospital morgue
Then we attempt to deal with the loss
Remember to do self-care later
State special considerations in surgery for patients with special needs.
Pediatrics:
increase room temperature to 80 degrees F
Provide them with a warm blanket
“cap & wrap”; cover head with stocking cap
Age appropriate communication, especially non-verbal
Do NOT tell them that they are “going to sleep”
Carefully Monitor blood loss closely
Meticulous asepsis
Bariatric
Extra people to help transport, move, and position
May transport patient in hospital bed
May need OR bed designed for bariatric patients
May place pillow/s under knees
Protect patient’s skin and tissue by using appropriate padding
Check properly all skin folds to make sure nothing is pinched
Place ESU grounding pad carefully to an area with the best muscle mass, ensure that the pad does not get kinked in body folds
Meticulous asepsis
Patients with diabetes
Meticulous asepsis
Provide Padding to protect them when positioning
Use sequential compression devices (SCD’s)
Pregnant patients
Postpone elective procedure
Delay an urgent procedure if possible to 2nd or 3rd trimester
Must do an emergent procedure
Fetal monitoring; monitor for contractions
Be prepared for c-section PRN
Immune-compromised
Meticulous asepsis
Antibiotic prophylaxis
Geriatric patients
Meticulous asepsis
Provide blankets, warming devices, may increase room temperature, monitor patient’s temperature throughout
Check ROM preoperatively and do NOT overextend joints when positioning
Use padding to protect bony prominences
Use caution when moving patient; care when retracting skin; care when removing drapes, ESU pad
Visual impairment
Let patient wear their glasses PRN
Contact lenses must be removed to avoid loss or damage
always speak before touching the patient
verbal tone caring and gentle
explain things clearly without using visual descriptions
speak in normal volume - do NOT yell – they aren’t deaf…
Hearing impaired
Allow patient to bring and wear hearing aids to OR and remove it when the procedure starts. (Make sure not to lose it)
Interpreter PRN; speak slowly and clearly w/o mask if they lip-read; non-verbal reassurance
Language
Interpreter if you have one; use non-verbal communication skills
Victims of Violence
Preoperative sedative; gentle demeanor; reassurance of safety
Substance abuse
Gentle tone and touch, be ready to break scrub if team needs help restraining patient
Be ready to help turn patient if they start to vomit
Trauma patients
Use caution when positioning to avoid further trauma, such as one person designated to stabilize fractured limb
Warming blankets PRN; raise room temp PRN
May have to limit patient skin prep; irrigate if time or after
Patients in Isolation
Utilize appropriate PPE; particulate respirator for patient if TB
Patients with PTS
Preoperative sedation; gentle care and tone, reassurance
Pay close attention at emergence, be ready to restrain patient for their safety, but don’t yell at them
State concepts for preservation of forensic evidence.
Carefully handle items and document everything!
Maintain shortest possible chain of evidence
Bullets – preserve markings
Do NOT handle with metal instruments
Make rubber shod clamp to extract bullet
Robinson catheter cut in segments and placed on clamp jaws
Do NOT drop bullet into metal basin
I’d suggest a towel rather than a sponge as stated in text
Don’t let countable sponges outside of OR
Put in plastic specimen cup or bag
State the appropriate attire for restricted, semi-restricted, and unrestricted areas of the surgical suite.
Restricted
OR attire plus masks required
These are areas of the suite where sterile items are open
Semi-restricted
OR attire required, but no masks required
Support areas of the suite and OR’s when not in use
Unrestricted
Street clothes may be worn
If you are in OR attire, keep contact with these areas to a minimum
These are exchange areas of the suite; change clothes here
State parameters for specified physical components of an operating room.
Electrical outlets
110 and 220-volt; mounted above the floor; monitored system;
ground fault-interrupters; explosion proof;
emergency outlets are red and connected to back up generator
Gas outlets
Connections to provide air, oxygen, and nitrous oxide (anesthesia)
nitrogen for powered equipment (power drills/saws)
Mounted on wall or suspended from ceiling; emergency shut-off valves in corridor; learn colors on next slide
Lights
Fluorescent lights for general room lighting
Surgical lights suspend from the ceiling above; has range of intensity and focus; puts off minimum heat; freely moveable/adjustable; easily cleaned; use sterile handle covers
Access doors
For room entry; keep closed during surgery to maintain positive room air pressure
sliding doors ideal (reduce air currents) but not commonly seen
Environmental control systems
Purposes are to clean air, remove contaminates, and provide comfortable environment (although patients still feel cold); but PRIMARY purpose is infection control.
Must maintain positive air pressure (what is that?)
HEPA filtered
20-25 air exchanges per hour
20% fresh air each hour
Temperature and humidity kept in range
Temperature range 68° - 73° F; Humidity range 20 – 60%
Identify surgical hazards
Ionizing radiation Electrical hazards Fire (from any cause) Laser fire Ergonomic hazards Equipment hazards Contaminated sharps Infectious waste Blood/body fluid Surgical plume Latex exposure (staff) Latex allergic (patients) Anesthetic gases Chemical sterilants Disinfectants Polymethyl methacrylate (bone cement)
List method to prevent injury from Ionizing radiation
Decrease time of exposure
Use shielding (lead aprons, thyroid shield, lead wall)
increase distance
List method to prevent injury from Electrical hazards
Do not use frayed cords and do not pull by cord, rather pull cord by grasping plug as well as avoid water when using electrical equipment
Follow manufacturer’s instructions
Use grounded plugs
Use grounding pads when using monopoly ESU
List method to prevent injury from Fire (from any cause)
Always have a moist sponges or towels near
Do not use flammable prep solutions used, but allow alcohol-based prep solutions to dry (for 3 minutes) thoroughly before incision
Holster the ESU when not in use EVERY TIME
Don’t use frayed electric cords of any kind (sterile or unsterile)
List method to prevent injury from Laser Fire
Sterile water to moisten sponges and towels near operative site, to reduce risk of ignition and to extinguish small fire on patient.
Use non-reflective instruments
keep patient’s hair covered with moist towels if near surgical site
List method to prevent injury from Ergonomic Hazards
Use good body mechanics when lifting
Stand with legs shoulder-width apart
Stand at correct height for Mayo stand to avoid shoulder strain
Push, don’t pull heavy equipment; lift with legs, not back
List method to prevent injury from Equipment hazards
Be aware of surroundings such as Height of surgical lights, Placement of cords and tubings to avoid trip hazard and watch out for kick buckets to avoid injury
List method to prevent injury from Contaminated Sharps
Use standard precautions
List method to prevent injury from Infectious waste
Use Standard Precautions such as bagging (red) more than household levels of BBF
List method to prevent injury from Blood/body Fuid
Use Standard Precautions such as wear personal protective equipment (PPE), goggles, masks, gowns, double-gloves
List method to prevent injury from Surgical Plume
Use proper PPE such as laser masks or Plume evacuation/filtering
List method to prevent injury from Latex allergic (patients)
First determine if it is a true allergy
then Use special latex-free supplies
Nitrile or other non-latex gloves for all team members
