unit V Flashcards
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Time decision is made to have surgery until transported to the OR
Preoperative
Administration of anesthesia through completion of surgery
Intra-operative
Post anesthesia care unit until recovery is complete
Post operative
Peri operative nursing is a planned process based on?
The nursing process Assess Planning Implement Evaluate
Standardized policies and procedures are important for?
Pt safety
Easier to teach pt
Help maintain quality of practice
Continuity of care for total surgical experience
Pt admitted & surgery performed in the hospital surgical suite
Inpatient
Approximately 80% of surgeries are now?
Outpatient aka
Ambulatory surgery
What are some advantages of out patient surgery?
Less costly
Inpatient beds for very I’ll
Disadvantages of outpatient
Responsible for own pre op preparation
Name some criteria for out patient surgery
Age
General health
Pt willingness
Insurance requirements
Simple surgery that presents little risk to life
Performed in dr office
Minor surgery
Involves extensive reconstructive or alteration in body part
Major surgery
Performed to determine cause of symptoms or verify diagnosis
Diagnostic or exploratory surgery
Removal of diseased part, repair damaged or malformed area, removal of early stage rumors
Curative surgery
Removal of diseased part
Ablative
Strengthen a weakend area
Restorative surgery
Repair malformations or improve function/appearance
Constructive or reconstructive surgery
Relieves symptoms without curing disease
Palliative
Replace an organ
Transplant
Surgery performed due to major trauma or hemorrhage of internal organs, done to save life or body part
Emergency: unplanned
Requires surgical intervention within 24-48 hrs
Urgent: unplanned
Indicated for health problems but not necessary immediately to preserve life or function
Ex. Knee replacement
Required: planned
Scheduled weeks or months in advance, if delayed there are no adverse effects
Elective: planned
Removal of an organ or gland
Ectomy
Suturing or stitching
Orrhaphy
Providing an opening
Ostomy
Otomy
Cutting into
Scopy
Looking into
What must the pt sign before surgery?
Informed consent form
The consent form protects who?
Pt, hospital, staff & surgeon
Who has to fully explain the procedure including risks & benefits
The physician
How long is an informed consent good for?
60 days
What is the first thing you assess?
Anxiety level
What are the three phases in the perioperative period
Per operative
Intra operative
Post operative
Good nutrition is essential for ?
Wound healing & infection
What is the purpose of nursing associations?
Gain new knowledge and improve nursing care
Free standing surgical unit
Not connected to the hospital in any way
Independently owned and operated
Simple surgery that presents little risk of life
Minor surgery
Involves extensive reconstruction or alteration of body part
Major surgery
Name the factors that affect risk
Age General health Nutrition Medications Mental status
When can treatment be given with out consent
Immediate life threat to life or health, condition cannot be delayed
What decrease level of anxiety?
Information, understanding of what’s going on
Why do we do pre op teaching?
Reduces anxiety
Requires less anesthesia & analgesia
Lowers infection rates
Lowers pulse & b/p
What information ate you giving to the pt during pre op teaching
Purpose of surgery Tests need to be done Pre op routines Schedules What to expect after surgery Post op therapies
How will you know that the pt understands your teachings?
Return demonstration
Verbalized
What is a collection of subjective & objective data that provides baseline information
Physiological preparation
Why is physiological preparation used
Identify & correct any risks factors
Est. baseline data for comparison
Plan pre op care
Select anesthesia
Baseline data includes
General health/previous surgeries Allergies Rx/smoking/ETOH Prothesis Mobility limitations Body size LOC Height weight
During the physical assessment what are you looking for in the Respiratory system?
Hx of resp allergies Asthma COPD smoking hx Lung sounds Breathing exercises
During the physical assessment what are you looking for in the cardiovascular system
Angina MI HTN Peripheral vascular disease (DVT) VS (all pulses, heart rate & rhythm)
If you have a pt with abnormal potassium what could this cause?
Cardiac arrhythmia
During the physical assessment what are you looking for in the renal system
Decrease function increases toxicity
Check I&O
May need electrolyte replacement prior to surgery
What lab values are used to check for renal function
BUN
Creatin
(Check kidney function)
During the physical assessment what are you looking for in the endocrine system
Diabetic risks
Delayed wound healing
Lab tests-ketones in urine
During the physical assessment what are you looking for in the hepatic system
(liver)
Metabolizes Rx
PRIMARY concern for anesthesia
During the physical assessment what are you looking for in the neurological system
Orientation
Alertness
Hx of seizures, epilepsy
During the physical assessment what are you looking for in the musculoskeletal system
Positioning
Airway management
During the physical assessment what are you looking for in the immune system
Hx of HIV
Autoimmune disease
Chemotherapy (risk for infection)
Steroids (lowers immune system)
What is important in determing pt outcomes during & after surgery
Surgical risk factors
The degree of surgical risk depends on
Physical & mental condition
Extent of pre existing disease
Severity of required operation
Why is at the greatest surgical risk
Very young
Very old
Protein is an essential component for?
The building & repair of tissues and to fight infection
Why is obesity a high risk
Excessive amt of fat
Longer anesthesia time
High risk intra op complications
What side effects can radiation have
Decrease of collagen
Delayed wound healing
What is the overall goal of pre op period
Ensure pt is mentally & physically prepared for surgery
What is your expected outcome of the surgery
Decrease complications & length of stay in hospital
During the physical preparation the evening prior why do you want to prep the bowel
Decompress the bowel, so not to obstruct access to the organs, prevents incontinence or contamination
During the physical preparation the evening prior, what does skin preparation do
Decreases the # of microorganisms at the surgical site.
During the physical preparation the evening prior, what does sleep & rest provide?
Manage stress
Reduce anxiety
During the physical preparation the evening prior, why are pt’s NPO after MN?
Nothing by mouth after midnight
Reduces possibility of vomiting & aspiration during anesthesia
During the physical preparation of the day of surgery you can not enter the OR without?
History & physical & OR checklist
Name purposes of pre op Rx.
Relieves anxiety Provides analgesia Prevents N & V Prevents post op infections Decreases anesthetic requirements Prevents gag reflex Decreases respiratory & GI secretions
Pre op rx’s are ordered by?
Anesthesiologist or surgeon
Antibiotics and anti emetics are given when?
30-60 minutes prior to surgery
When are anticholinergics & benzodiazepines given
Given just prior to OR
Once pre op Rx’s are given what must happen
Pt must remain in bed with side rails up, call bell in reach
Normal WBC count
4,000-10,000
4-10
The whit blood cells are made up of what 5 components
Neutrophils Lymphocytes Monocytes Basophils Eosinophils
What do whit blood cells do?
Fight infection
Basophils & eosinophils do what?
Activate allergy response
Monocytes do what?
Eat bacteria (long lasting)
Neutrophils & lymphocytes do what?
Fight infection
Last short time 6 hrs
Neutrophils
Eat, clean up bacteria
Lymphocytes
Fight chronic or bacteria infections
Normal RBC count
Male 4.7-6.1
Female 4.2-5.4
What do hemoglobin do?
Carry oxygen
Normal hemoglobin levels
Male 14-18
Female 12-16
If your WBC count is low, what kind of disease could it be?
Chronic
If your WBC count is high, it can be a sign of ?
Acute infection
Hematocrit
Percentage of total blood volume made up by RBCs
What is the normal hematocrit %
Male 42-52%
Female 37-47%
Platelets
Essential for blood clotting
Normal platelet count
150,000-400,000
If your RBC count is low what could be the cause
Blood loss
Not making enough blood
Sodium (Na+)
Normal 135-145
Balance between dietary intake and renal excretion
If you have an imbalance of electrolytes what could happen?
Cardiac problems
Potassium (K+)
Normal 3.5-5.0
Imbalance can cause cardiac arrhythmia or cardiac arrest
Carbon dioxide (CO2)
Normal 23-30
Assists with Ph balance
Chloride (Cl)
Normal 98-106 mEq
Acid base balance
Calcium (Ca+)
Normal 7.6-10.4 mg/dl
BUN
Blood urea nitrogen
Normal 10-20
Monitors kidney function
Increase of BUN could indicate?
Dehydration
Creatin
Normal 0.5-1.1
Monitors kidney function
What labs monitor kidney function
Creatinine & BUN
Urinalysis is used to identify ?
UTI, renal function, diabetes
If pt is at high risk for blood loss what lab is ordered?
Type & cross match
ABG
Arterial blood gases
Oxygenated blood
Drawn by respiratory
FBS
70-100
PTT, PT/INR, bleeding time
Clotting factors
Done for surgery or if on blood thinners
Albumin/protein
Measure of nutrition
ALT
Normal 4-36
Monitors liver function
CXR
Chest x ray
Examine condition of heart & lungs
EKG
Measures hearts electrical activity
Over age of 40 & heart Hx
PFT
Pulmonary function test
A planned anatomical alteration of the body
Surgery
