Unit 5 Pre-op Flashcards
Phases of Surgery
- Preoperative
- Intra-operative
- Post-operative
Preoperative
time decision is made to have surgery until transported to the OR
Intra-operative
administration of anesthesia through completion of surgery
Post-operative
Post-anesthesia care unit until recovery is complete
Can be years!
Surgery
planned anatomical alteration of the human organism designed to arrest, alleviate, or eradicate some pathological process
anatomical alteration of the body
Palliation/ Palliative
Does NOT cure; Alleviates symptoms
relieves symptoms without curing disease
Think Hospice
Perioperative period
(encompasses 3 phases)—around the surgery
Perioperative Nurse
allows nurse to function in variety of roles within the surgical process–> CONTINUITY OF CARE
Inpatient
patient admitted and surgery performed in the hospital surgical suite
must stay in hospital at least over night
Ambulatory Surgery
Outpatient
~70-90% of surgeries are not outpatient
Free Standing
not affiliated w/ hospital; independently owned & operated
Hospital affiliated facility
- Sep. department (for all 3 phases)
* Located w/in hosp complex or satellite office
Minor Surgery
simple surgery that presents little risk to life (may not be minor to patient!)
Major Surgery
involves extensive reconstruction or alteration in body part
Diagnostic/Exploratory
to determine cause of symptoms or verify diagnosis
Curvative
removal of diseased part, repair damaged or malformed area, removal of early stage tumors
Ablative
removal of diseased part ** total !!!
Restorative
strengthen a weakened area
bone pinning, herniorrophy (suture repair of hernia), mitral, valve replacement
Constructive/reconstructive
repair malformations or improve function/appearance.
Plastic, cleft palate, plastic surgery, breast reconstruction
-ECTOMY
removal of an organ or gland
-lysis
destructive
-orrhaphy
suturing or stitching
-ostomy
providing an opening
-otomy
cutting into
-plasty
formation or plastic repair
-scopy
looking into
Emergency Surgery
unplanned – preformed immediately to save life***
- to save life or body part
Performed due to major trauma or hemorrhage of internal organs.
Informed Consent
- Prior to any non-emergency surgery
- Must Have: clear understanding of the surgery, risks, and benefits w/ clear judgment –no impairments *
- Surgery cannot legally be performed until patient understands and signs consent
- protects: patient, hospital, staff, & surgeon
- valid for 60 days
- must be witnessed
Urgent Surgery
Unplanned. Requires surgical intervention within 24-48 hrs
Required Surgery
Planned; Required
Indicated for health problems but not immediate
full explanation of the procedure in terms the patient can understand prior to signing is performed by
the physician
Elective
- planned; desired
- Scheduled weeks or months in advance
AORN
Asc. Of Operating Room Nurses
Purpose: gain new knowledge and improve nursing care in the OR; Develop standards of practice for the OR
Subjective Data
Pt level of understanding/perceptions
Subjective Data Assessments
- Site/ type of surgery/ reason for surgery
- extent of hospitalization, limitations
- pre-op/ post-op routines/ tests required
- surgical experiences/ specific concerns about present surgery
- religion or cultural beliefs
- family/significant other source of support
WBC
Total White Blood Cell Count
Fight Infection
4,000-10,000 (4-10 on lab print out)
Neutrophils
2nd line of defense
Lymphocytes
1st line of defense
Potassium
Major Cation within cells
3.5-5.0
**Minor Changes have significant consequences
Abnormal Ranges increase risk of cardia arrhythmia
• Excreted by the kidneys
Sodium (Na+)
maj determinant of extracellular osmolality
Norm: 136-145
Carbon Dioxide
- Norm: 23-30 mEq
* pH status of pt and other electrolytes
Cl-
- 98-106 MeQ
- → indication of acid-base balance
- Maintain electrical neutrality with Na+
Ca+
7.6-10.4 mg/dl
parathyroid funx, ca+ metabolism, monitor renal funx
Collection of subjective & objective data provides
baseline information (DAY 2) • identify & correct any risk factors • establish baseline data for comparison • plan & institute pre-op care • select anesthesia
Pre-op physical assessment includes
- physical assessment
- pre-surgical test results
- identification of surgical risk factors
Baseline Data Includes
- General health/previous surgeries
- Allergic responses
- Medications/smoking/ETOH
- prosthesis: dentures, glasses, etc
- disabilities/impairments
- mobility limitations
- body size & structure
- level of consciousness
- mental status/ coping/support
- pregnant
- Body surface area
smoking history –>
↓ ciliary action to remove secretions
irritating to tracheobronchial passages →lyringo spasms
Hepatic
detoxifies drugs - primary concern for anesthesia
malnutrition
state of impaired functional ability of essential nutrients & calories within cells
obesity
excessive accumulation of fat ↑surgical risk
• Adipose tissue is avascular
• More adipose tissue, more technical difficulty
– longer anesthesia time
– higher risk of intraop complications
adrenocortical stress response
results in sodium & water retention/ potassium loss
Radiation Therapy
- Side effects that may affect surgery/healing
- -thin skin layers
- -breaks down collagen for less healing potential
- -scars tissue-fibrotic & changes vascularity
- Ideally, wait 4-6 weeks after radiation to do surgery.
Overall goal of pre-op period
to ensure patient is mentally & physically prepared for surgery
Purposes of Pre-op Medication
Prevents N/V, autonomic reflex response, post-op infections – antibiotics
Decreases anesthetic requirements,respiratory & GI secretions –> prevents aspiration; anticholorgenic
Relieves apprehension & anxiety –>Promotes sedation & amnesia –>Facilitates induction of anesthesia
Pre-op Medications:
• ordered by anesthesiologist or surgeon
Antibiotics & anti-emetics:
given 30-60 minutes prior to surgery
Once pre-op meds are given:
- patient to remain in bed with side rails up, call bell in reach
- DOCUMENT: explained to patient need to remain in bed
What to expect when love one comes out of surgery
- Not awake
- Say incoherent things
- Pale
- Special Equipment
- Frequent Vital Signs
BUN
- 10-20
* Monitors Kidney Function
• Creatine
- 0.5-11
* Monitors Kidney Fun
Urinalysis
• UTI, renal function, diabetes
• Type & Cross Match
• High risk for blood loss, sufficient blood for pt during surgery
ABG’s
arterial blood gases
• Pregnancy Test
Female pt of childbearing age
• Clotting Factor
- PTT – Prothrombin Time
* PT/INR- Pro Time/ International Ratio – normally between 1&2
• Bleeding Time
how long… done on “wheel”
FBS
- Fasting Blood Sugar
* Thick blood → decrease flow → increase clot
Albumin/Protein
important for osmotic press. w/ in vascular space
• Measure of Nutrition
• ALT
(alanine aminotransferase)
(alanine aminotransferase)
Norm: 4-6
Liver enzyme → indicates any damage to liver
EKG
measures heart electrical activity
• Rate, Rhythm & other factors
• ID Pre-existing cardiac problems
• Pt >40 years/ or hist of heart disease
PFT
pulmonary function
Anticholinergics & benzodiazepines:
given just prior to OR
Hematocrit
% of total red blood volume made up of RBC
• M: 42-52%
• F: 37-47%
Platelets
essential to blood clotting
• 150,000-400,000
Bowel Prep
empty bowel of fecal material ‘
Collapse or “decompress” bowel so not obstruct access to organs or be nicked during surgery; prevents incontinence & contamination of surgical; prevents post-op constipation r/t decreased peristalsis; prevents uncomfortable straining first dew days post-op → dangerous for rectal, prostate & eye surgery; PERISTALSIS DOES NOT RETURN FOR 24 HOURS
Objective Data: clues to anxiety level
- speech patterns -rept themes
- degree of interactions with others
- physical-pulse/ respirations,hand movements, perspiration, activity level, frequent voiding
- change in sleep patterns
biggest fear
will not wake up
a stressor, a potential or actual threat to body integrity; Always a major experience for pt
surgery
