UNIT 4 & 5 - Surgery Flashcards
Types of operating theatre
- Orthopedics
- ENT
- Emergency
- Neurosurgery
- Cardiothoracic
- Ophthalmology/ Eyes
Preoperative phase
Begins when the patient and surgeon decide that surgery is necessary and ends when patient ends in operating theatre or procedural bed.
Intraoperative phase
Begins when the patient is transferred to the operating room bed and end when the patient is transferred to postoperative recovery room.
Intraoperative core team
Circulating nurse, Contingency team (Cardiovascular perfusionist) Anesthesiologist, Surgeon, Scrub Nurse
Postoperative phase
Lasts from admission to the recovery room to complete recovery from surgery and last follow-up physician visit.
Elective surgery
Procedure that is preplanned.
Can be scheduled in advance based on patient’s choice
Urgent surgery
Must be done within 24-48h to preserve health
Emergency surgery
Done immediately
Major surgery
May be elective, urgent or emergency
involves major body organs or life-threatening situations
E.g., Ruptured Spleen, Amputation, Colostomy, Hysterectomy
Minor surgery
Primary elective that is brief and carries low risks whilst resulting in fewer complications.
Performed in office, outpatient, same-day
E.g., Teeth extraction, Skin biopsy, Cataract extraction
Diagnostic surgery
To make or confirm a diagnosis
E.g., Bronchoscopy, Biopsy. Exploratory laparotomy
Ablative surgery
To remove a diseased body part. Example Appendectomy
Palliative surgery
To relieve or reduce the intensity of an illness, is not curative.
Reconstructive surgery
To restore function to traumatized or malfunctioning tissue
To improve self-concept. Example: Plastic surgery, skin graft
Transplantation surgery
To replace organs or structures
that are diseased or malfunctioning
Example: Kidney, heart
Constructive surgery
To restore function in congenital
anomalies. Example: Cleft palate repair
Nurse’s responsibilities on arrival of patient to OT
- Correct patient
- Signage of informed consent
- Correct surgery
- Established NPO status, pre-medication as ordered, allergies, appropriate clothing
General anesthesia
Administration of anesthetic drugs is by inhalation or intravenous route
Jana experienced loss of consciousness after inhaling general anesthesia. The surgical team waited until it was time for incision.
Induction
Veondre had her stomach incised under general anesthesia and her surgery was completed.
Maintenance
Yulia began to wake up from her general anesthesia
Emergence
Phases of general anesthesia
Induction
Maintenance
Emergence
Regional anesthesia
Agent injected near a nurse in or around the operative site
Patient remains awake and loses sensation in a specific area of the body
Examples of regional anesthesia
nerve blocks
caudal anesthesia
spinal anesthesia
Nerve blocks
injecting local anesthesia around a nerve trunk supplying the area of surgery such as the jaw, face and the extremities
Caudal anesthesia
injection into the epidural space through the caudal in the sacrum used for procedures on lower extremities or perineum
Spinal anesthesia
injecting local anesthesia into the subarachnoid space through a lumbar puncture, causing sensory and motor blockage
For surgery of lower abdomen, perineum, legs but can cause hypotension, headache and urine
Anticoagulants increase surgical risk
Hemorrhage
Diuretics increase surgical risk
Electroyle imbalance
Sedatives increase surgical risk
Hypotensive effects of agent
Antidiabetic medications increase surgical risk
Abnormal blood sugar
What criteria makes a patient fit for discharge from recovery room?
Patient is awake, cough well, expel/spit out the oral cavity, deep breath at normal rate and depth.
Moves 2 - 4 extremities voluntarily or on command and can lift head
Stable BP & pulse within 10 - 20 mmHg of pre-op values
Awake, alert and oriented in time, place
Skin color pink and warm
